CMS Price Transparency Data

X-ray, shoulder

Facility: St Mary's General Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $108
Cash Discount Price: $102
vs. Medicare Baseline: 1.21x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at St Mary's General Hospital is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $102. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.21x the Medicare baseline. Located in 350 Boulevard, Passaic, NJ.

Cash / Self-Pay

$102

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

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: $102 (115%)

Insurance Median: $108 (121%)

Cash: $102 (115% of Medicare)

Ins. Median: $108 (121% 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.

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	$50 - $103	56%
UnitedHealthcare	$81 - $121	91%
Humana	$82	92%
Aetna	$103 - $218	116%
Clover Health	$103	116%
Horizon	$103 - $182	116%
Medicare (plans)	$103	116%
Tricare	$103	116%
Wellcare	$103 - $139	116%
Wellpoint Amerigroup	$103	116%
Ally-Align (Fka Spartan Plan Nj, Inc.)	$108	121%
Employer Direct Healthcare	$144	162%
Cigna	$151	170%
Fairprice Healthcare Holdings	$165	186%
Coventry	$206	232%

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 $102.
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 St Mary's General 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.