CMS Price Transparency Data
X-ray, shoulder
Facility: Mercy Hospital Carthage
Billing Code: 73030 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 73030
- Insurance Median: $256
- Cash Discount Price: $260
- vs. Medicare Baseline: 2.88x Medicare
The contracted insurance negotiated median rate for a X-ray, shoulder at Mercy Hospital Carthage is $256. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $260. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.88x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.
Cash / Self-Pay
$260
Average discount available for prompt cash payment at this facility.
Insurance Median
$256
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: $260 (292%)
Insurance Median: $256 (288%)
Cash: $260 (292% of Medicare)
Ins. Median: $256 (288% 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 288% of the Medicare baseline (a markup of 188%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $22 - $427 | 25% |
| Humana | $22 - $144 | 25% |
| Medicaid / KanCare | $22 - $264 | 25% |
| United Medical Resources Contracted [320454] | $44 - $432 | 49% |
| UnitedHealthcare | $44 - $418 | 49% |
| Blue Cross Blue Shield | $49 - $132 | 55% |
| Medicare (plans) | $82 - $142 | 92% |
| Cherokee Nation Health Serv Contracted [320066] | $88 - $132 | 99% |
| Cigna | $88 - $432 | 99% |
| Cross Timbers Hospice [20098] | $88 - $132 | 99% |
| Dept Of Veteran Affairs Contracted [320106] | $88 - $132 | 99% |
| Elara Caring Aspire Hospice [20433] | $88 - $132 | 99% |
| Globalhealth Contracted [320145] | $88 - $132 | 99% |
| Halo Hcr Inc Hospice Contracted [320432] | $88 - $132 | 99% |
| Halo Hcr Inc Hospice [20432] | $88 - $132 | 99% |
| Indian Health Service Contracted [320198] | $88 - $132 | 99% |
| Kindful Hospice Contracted [320434] | $88 - $132 | 99% |
| Kindful Hospice [20434] | $88 - $132 | 99% |
| Medical Associates Health Contracted [320444] | $88 - $132 | 99% |
| Mercy Hospice Okc [20252] | $88 - $132 | 99% |
| Mercy Mgd Behavioral Health Contracted [320259] | $88 - $132 | 99% |
| Pace Of The Ozarks Contracted [320518] | $88 - $132 | 99% |
| Provider Partners Health Plans Contracted [320450] | $88 - $132 | 99% |
| Qual Choice Contracted [320325] | $88 - $132 | 99% |
| Tricare | $88 - $132 | 99% |
| Point C Contracted [320238] | $112 - $432 | 126% |
| Health Systems Inc Contracted [320174] | $138 - $206 | 155% |
| Insurance System Inc Contracted [320465] | $138 - $206 | 155% |
| Administrative Payor Contracted [320005] | $144 - $216 | 162% |
| Centivo Contracted [320505] | $147 - $221 | 165% |
| Healthscope Contracted [320182] | $167 - $250 | 188% |
| Ambetter / Centene | $176 - $264 | 198% |
| Home State Health Plan Contracted [320187] | $176 - $264 | 198% |
| Novasys Contracted [320285] | $176 - $264 | 198% |
| Benefit Management Contracted [320052] | $192 - $418 | 216% |
| Auxiant Contracted [320462] | $208 - $408 | 234% |
| Healthlink Contracted [320179] | $208 - $446 | 234% |
| Preferred Health Plan Contracted [320522] | $208 - $312 | 234% |
| Workers Comp [20426] | $256 - $480 | 288% |
| 90 Degree Benefits Contracted [320436] | $272 - $408 | 306% |
| Aither Health Contracted [320449] | $272 - $408 | 306% |
| Ebms Contracted [320493] | $272 - $408 | 306% |
| Edison Health Solutions Contracted [320502] | $272 - $408 | 306% |
| Imagine 360 Contracted [320494] | $272 - $408 | 306% |
| Mercy Benefit Admin Contracted [320251] | $272 - $432 | 306% |
| Reflect Health Contracted [320492] | $272 - $408 | 306% |
| Show-Me Health Administrators Contracted [320483] | $272 - $408 | 306% |
| Yuzu Health Contracted [320521] | $272 - $408 | 306% |
| Medica Contracted [320239] | $277 - $416 | 312% |
| Evolutions Health Care Contracted [320124] | $278 - $418 | 313% |
| First Health Contracted [320128] | $278 - $418 | 313% |
| Multiplan Contracted [320270] | $278 - $418 | 313% |
| Private Health Care Systems Contracted [320320] | $278 - $418 | 313% |
| American Healthcare Alliance Contracted [320020] | $288 - $432 | 324% |
| Ppo Plus Contracted [320310] | $288 - $432 | 324% |
| Usa Managed Care Org Contracted [320429] | $288 - $432 | 324% |