CMS Price Transparency Data

X-ray, shoulder

Facility: Down East Community Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $151
Cash Discount Price: $228
vs. Medicare Baseline: 1.70x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Down East Community Hospital is $151. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $228. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.70x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$228

Average discount available for prompt cash payment at this facility.

Insurance Median

$151

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$88.91

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $88.91 (100%)

Cash / Self-Pay: $228 (256%)

Insurance Median: $151 (170%)

Cash: $228 (256% of Medicare)

Ins. Median: $151 (170% of 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.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$32 - $432	36%
Humana	$32 - $235	36%
Wellcare	$32 - $235	36%
Partners Direct Health	$36 - $268	40%
Aetna	$60 - $447	67%
Community Health Options	$60 - $443	67%
UnitedHealthcare	$62 - $460	70%
Cigna	$65 - $483	73%
Martins Point	$65 - $482	73%
Patients Advocates	$65 - $482	73%
Harvard Pilgrim	$66 - $490	74%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $228.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 73030.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Down East Community Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 73030.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.