X-ray, shoulder
Facility: Memorial Hospital
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $308
- Cash Discount Price: $348
- vs. Medicare Baseline: 3.46x 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 346% of the Medicare baseline (a markup of 246%). 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 |
|---|---|---|
| Medicare (plans) | $40 - $312 | 45% |
| Ambetter / Centene | $43 - $339 | 48% |
| Coventry - All Other Plans | $71 - $555 | 80% |
| Preferred Healthcare-All Plans | $75 - $586 | 84% |
| Blue Cross Blue Shield | $148 | 166% |
| Tricare | $308 | 346% |
| Humana | $308 | 346% |
| Health Partners Of Kansas - All Plans | $586 | 659% |
| Wppa/Providers Care-All Plans | $864 | 972% |
Consumer Guidance & Cost Commentary
For this X-ray of the shoulder at Memorial Hospital in Abilene, KS, the cash price is $348.00, which matches the facility's median negotiated rate of $308.00 and the cash median. While the facility is a Critical Access Hospital with a government ownership structure, the negotiated rates for various payers range from $40 to $864, with a median negotiated amount of $308.00. It is important to note that commercial insurance plans often pay significantly more than the cash price due to administrative costs and contract structures; for instance, the gross charge is $348.00, but the Medicare benchmark is $88.91, indicating that commercial rates can be several times higher than the federal baseline. Patients with high-deductible plans may find that paying the cash price of $348.00 upfront is more cost-effective than relying on insurance, especially since the median amount paid by insurers is $288.00, which may still leave the patient responsible for significant out-of-pocket costs if their deductible has not been met.
To minimize costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling the appointment, as these upfront payment incentives can reduce the bill by 20% to 50% by bypassing insurance claim processing fees. It is also crucial to request an itemized billing audit rather than accepting a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. Since the facility is located in a Critical Access Hospital network, the No Surprises Act may protect patients from