CMS Price Transparency Data

X-ray, shoulder

Facility: Alice Peck Day Memorial Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $383
Cash Discount Price: $270
vs. Medicare Baseline: 4.31x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Alice Peck Day Memorial Hospital is $383. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $270. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 4.31x the Medicare baseline. Located in 10 Alice Peck Day Drive, Lebanon, NH.

Cash / Self-Pay

$270

Average discount available for prompt cash payment at this facility.

Insurance Median

$383

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: $270 (304%)

Insurance Median: $383 (431%)

Cash: $270 (304% of Medicare)

Ins. Median: $383 (431% 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 431% of the Medicare baseline (a markup of 331%). 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
Ambetter / Centene	$15	17%
Nh Healthy Families	$16	18%
Blue Cross Blue Shield	$202 - $445	227%
Wellpoint	$202	227%
Medicaid / KanCare	$230	259%
Harvard Pilgrim	$311 - $434	350%
UnitedHealthcare	$360	405%
Tufts	$367	413%
Cigna	$383 - $409	431%
Commercial Generic	$383	431%
Connecticut General	$383	431%
Klais	$386	434%
Aetna	$450	506%
Mvp	$455	512%
Coventry Health	$475	534%
Coventry Health Wc	$475	534%
Humana	$520	585%

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 $270.
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 Alice Peck Day Memorial 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.