CMS Price Transparency Data

X-ray, shoulder

Facility: Progress West Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $216
Cash Discount Price: $199
vs. Medicare Baseline: 2.43x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Progress West Hospital is $216. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $199. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.43x the Medicare baseline. Located in 2 Progress Point Pkwy, Ofallon, MO.

Cash / Self-Pay

$199

Average discount available for prompt cash payment at this facility.

Insurance Median

$216

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: $199 (224%)

Insurance Median: $216 (243%)

Cash: $199 (224% of Medicare)

Ins. Median: $216 (243% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 243% of the Medicare baseline (a markup of 143%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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	$47 - $289	53%
Consociate [478]	$57	64%
Sarah Bush Lincoln [636]	$57	64%
Humana	$58	65%
Aetna	$78 - $249	88%
Allied Benefits [498]	$78 - $247	88%
Coresource [497]	$78	88%
Fmh Benefit Service Inc [222]	$78	88%
Mail Handlers [495]	$78	88%
Cigna	$80 - $89	90%
Apwu Health Plan [216]	$89	100%
Nalc Health Benefit Plan [242]	$89	100%
Priority Health [648]	$89	100%
Healthlink [225]	$161 - $251	181%
Cox Health Systems Insurance Company [220]	$183 - $216	206%
Health Alliance [224]	$183	206%
Hope Trust [806]	$193	217%
Med-Pay [480]	$216 - $249	243%
Unicare [568]	$216 - $251	243%
First Health Commercial [734]	$247	278%
UnitedHealthcare	$247 - $296	278%
Beechstreet [551]	$249	280%
Detego Health [868]	$249	280%
Health Systems Inc [620]	$249	280%
Healthcare Sol Mercy [609]	$249	280%
Multiplan Commercial [737]	$249	280%
Multiplan [240]	$249	280%
Phcs [244]	$249 - $266	280%
Preferred Health Professionals [561]	$251	282%
Hfn [563]	$266	299%
Medica [661]	$266	299%
Healthscope Benefits [258]	$296	333%
Mh Magellan Health Services [270]	$332	373%

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 $199.
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 Progress West 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.