CMS Price Transparency Data

X-ray, shoulder

Facility: Lexington Memorial Hospital Inc

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $206
Cash Discount Price: $233
vs. Medicare Baseline: 2.32x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Lexington Memorial Hospital Inc is $206. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $233. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.32x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$233

Average discount available for prompt cash payment at this facility.

Insurance Median

$206

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: $233 (262%)

Insurance Median: $206 (232%)

Cash: $233 (262% of Medicare)

Ins. Median: $206 (232% 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 232% of the Medicare baseline (a markup of 132%). 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
Amerihealth	$88 - $128	99%
Carolina Complete	$88	99%
Healthy Blue	$88	99%
Partners	$88	99%
UnitedHealthcare	$89 - $209	100%
Vaya	$89	100%
Wellcare	$89	100%
Alliance	$90	101%
Trillium	$90	101%
Medcost	$102 - $312	115%
Blue Cross Blue Shield	$126 - $202	142%
Aetna	$132 - $431	148%
Ambetter / Centene	$134	151%
Oscar	$149 - $205	168%
Cigna	$203 - $206	228%
Directnet	$275	309%
Healthgram Lexington Home Brands	$336	378%
Healthgram	$373	420%
Private Healthcare Systems	$382	430%
Beechstreet	$410	461%
Humana	$410	461%
Multiplan	$419	471%
National Provider Network	$419	471%

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 $233.
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 Lexington Memorial Hospital Inc 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.