CMS Price Transparency Data

X-ray, shoulder

Facility: Highlands Cashiers Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $228
Cash Discount Price: $511
vs. Medicare Baseline: 2.56x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Highlands Cashiers Hospital is $228. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $511. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.56x the Medicare baseline. Located in 190 Hospital Drive, Highlands, NC.

Cash / Self-Pay

$511

Average discount available for prompt cash payment at this facility.

Insurance Median

$228

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: $511 (575%)

Insurance Median: $228 (256%)

Cash: $511 (575% of Medicare)

Ins. Median: $228 (256% 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 256% of the Medicare baseline (a markup of 156%). 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
Apex Health	$102	115%
Cigna	$168 - $227	189%
Blue Cross Blue Shield	$174 - $184	196%
United	$176 - $310	198%
Wellcare	$179	201%
Amerihealth	$181	204%
Partners Health Management	$183	206%
Vaya Health	$183	206%
Amerihealth Caritas	$194	218%
Caresource	$225	253%
Medcost	$240 - $288	270%
Aetna	$245 - $371	276%
Magellan	$306	344%
Magellan Behavioral Health	$306	344%
Multiplan	$409	460%
Avalon Administrative Services	$434	488%
Prime Health	$450 - $460	506%

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 $511.
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 Highlands Cashiers 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.