X-ray, shoulder
Facility: Phillips County Hospital
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $312
- Cash Discount Price: $293
- vs. Medicare Baseline: 3.51x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Understanding this gauge: We use the federal Medicare rate of $88.91 as the cost baseline. Rates below the baseline represent excellent value. In-network commercial rates commonly hover around 150% - 250% of Medicare, while rates exceeding 300% are elevated. Hover over the green and blue markers to view detailed calculations.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 351% of the Medicare baseline (a markup of 251%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $140 - $279 | 157% |
| UnitedHealthcare | $276 - $344 | 310% |
| Health Partners-All Plans | $344 | 387% |
| Medicaid / KanCare | $344 | 387% |
Consumer Guidance & Cost Commentary
For this X-ray of the shoulder at Phillips County Hospital, the negotiated rates for major payers like Blue Cross Blue Shield and UnitedHealthcare range from $140 to $344, while the cash price is $293. This cash rate is notably lower than the negotiated amounts for most commercial plans, meaning patients with high-deductible plans or those without insurance could save money by paying upfront. It is important to note that while the facility is in-network for these carriers, the cash price often serves as a more efficient baseline for self-pay patients. To maximize savings, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing the administrative costs associated with insurance claims processing.
The facility's cash rate of $293 is also significantly lower than the Medicare benchmark of $88.91, which serves as the objective cost baseline for healthcare services. While commercial negotiated rates typically average 200% to 300% of Medicare, the cash price here remains competitive and avoids the potential for balance billing that can occur with out-of-network services. Although the No Surprises Act protects patients from unexpected balance billing for emergency care and non-emergency services at in-network facilities, patients should still review their itemized bills to ensure no unbundled codes or services not rendered are included. Given that over 80% of hospital bills contain errors, requesting a detailed, line-by-line audit before finalizing payment is a critical step to verify that all charges align with the negotiated or cash rates provided.