X-ray, shoulder
Facility: Clay County Medical Center
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $273
- Cash Discount Price: $294
- vs. Medicare Baseline: 3.07x 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 307% of the Medicare baseline (a markup of 207%). 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 |
|---|---|---|
| Multiplan- All Plans | $9 - $286 | 10% |
| UnitedHealthcare | $11 - $286 | 12% |
| Aetna | $17 - $280 | 19% |
| Wppa/Providrs Care- All Plans | $17 - $280 | 19% |
| Health Partners - All Plans | $18 - $286 | 20% |
Consumer Guidance & Cost Commentary
For this X-ray, shoulder procedure at Clay County Medical Center in Clay Center, KS, the cash price is $294.00, which matches the facility's median negotiated rate of $273.00 and the state average. While the facility is a Critical Access Hospital with a government-local ownership structure, the cash price is notably higher than the Medicare benchmark of $88.91, reflecting a markup common in commercial billing. Patients with high-deductible plans may find this cash price advantageous if their insurance negotiated rate exceeds $294.00, as paying out-of-pocket could result in immediate savings compared to the administrative costs and potential balance billing associated with insurance claims.
To maximize potential savings, consumers should verify if the facility offers a prompt-pay discount, which could reduce the $294.00 cost by 20% to 50% for upfront payment. It is crucial to request this self-pay or prompt-pay rate before scheduling services and to sign a waiver preventing automatic claims submission to ensure the discount applies. Additionally, since the facility is in-network for multiple payers including UnitedHealthcare and Aetna, patients should confirm their specific deductible status and allowed amounts, as paying the full cash price might still be more expensive if the insurance plan has not yet met its deductible threshold.