X-ray, shoulder
Facility: Trego County Lemke Memorial Hospital
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $192
- Cash Discount Price: $200
- vs. Medicare Baseline: 2.16x 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 216% of the Medicare baseline (a markup of 116%). 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 |
|---|---|---|
| Humana | $115 | 129% |
| Tricare | $124 | 139% |
| Va Ccn - All Plans | $146 | 164% |
| Medicaid / KanCare | $146 - $235 | 164% |
| Aetna | $146 - $212 | 164% |
| UnitedHealthcare | $146 - $235 | 164% |
| Ambetter / Centene | $160 | 180% |
| Blue Cross Blue Shield | $192 | 216% |
| Health Partners - All Plans | $223 | 251% |
| Healthy Blue Mcaid - All Plans | $235 | 264% |
Consumer Guidance & Cost Commentary
For the X-ray, shoulder procedure (CPT 73030) at Trego County Lemke Memorial Hospital in Wakeeney, KS, the facility's cash price is $200.00, which is lower than the median negotiated rate of $192.00 paid by most insurers and significantly below the gross charge of $235.00. While the facility is a Critical Access Hospital with government local ownership, patients should be aware that commercial insurance rates often exceed cash prices due to administrative costs and contract structures; in this case, paying out-of-pocket directly could save money compared to standard insurance reimbursement. The facility's cash rate is also notably higher than the Medicare benchmark of $88.91, illustrating how commercial pricing can deviate from federal cost baselines, though it remains competitive relative to the high end of negotiated rates seen with payers like UnitedHealthcare and Healthy Blue Medicaid.
To minimize unexpected costs, patients should verify their specific plan's deductible status before scheduling, as many commercial payers will only cover the negotiated rate after the deductible is met, potentially leaving the patient responsible for the full $235.00 gross charge if the insurance payment is low. Additionally, since the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should request a formal itemized bill to ensure no unbundled charges or services not rendered are included. If the patient chooses to pay directly, they should explicitly ask for a "self-pay" or "prompt-pay" discount at registration, as paying upfront can sometimes bypass the higher administrative fees embedded in insurance contracts and result in a final bill closer to the cash median of $2