CMS Price Transparency Data

X-ray, shoulder

Facility: Hospital for Special Surgery

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $302
Cash Discount Price: $665
vs. Medicare Baseline: 3.40x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Hospital for Special Surgery is $302. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $665. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 3.40x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$665

Average discount available for prompt cash payment at this facility.

Insurance Median

$302

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: $665 (748%)

Insurance Median: $302 (340%)

Cash: $665 (748% of Medicare)

Ins. Median: $302 (340% 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 340% of the Medicare baseline (a markup of 240%). 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
Fidelis	$7 - $8	8%
UnitedHealthcare	$7 - $643	8%
Emblem	$10 - $13	11%
Metro Plus	$10	11%
Blue Cross Blue Shield	$13 - $1,104	15%
Horizon	$15	17%
Nyship	$16	18%
Cigna	$20 - $643	22%
Aetna	$22 - $238	25%
Fidelis Essential [1323]	$34 - $106	38%
Christian Brothers [1034]	$214 - $238	241%
Meritain Health [1085]	$214 - $238	241%
Nippon Life [1092]	$214 - $238	241%
Webtpa [1356]	$214 - $238	241%
Oxford [1096]	$233 - $301	262%
Emblem Health [1043]	$234 - $1,104	263%
Student Resources [1103]	$234 - $302	263%
Harvard Pilgrim [1057]	$270 - $348	304%
Geha [1053]	$302	340%
Affinity By Molina Health Plan [1005]	$345 - $643	388%
Connecticare [1039]	$356 - $1,104	400%
Apwu [1016]	$374 - $643	421%
Nalc [1090]	$374 - $643	421%
Qualcare [1101]	$374 - $643	421%
Wellfleet [1361]	$374 - $643	421%
Medicare (plans)	$643	723%

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 $665.
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 Hospital for Special Surgery 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.