CMS Price Transparency Data

X-ray, shoulder

Facility: UPMC Pinnacle Hospitals

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $100
Cash Discount Price: $188
vs. Medicare Baseline: 1.12x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at UPMC Pinnacle Hospitals is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $188. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 1.12x the Medicare baseline. Located in 409 South Second Street, Harrisburg, PA.

Cash / Self-Pay

$188

Average discount available for prompt cash payment at this facility.

Insurance Median

$100

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: $188 (211%)

Insurance Median: $100 (112%)

Cash: $188 (211% of Medicare)

Ins. Median: $100 (112% 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
UnitedHealthcare	$22	25%
Amerihealth Caritas	$32	36%
Health Partners Plans (Jefferson Health Plan)	$34	38%
Geisinger	$36	40%
Pa Health & Wellness	$42	47%
Blue Cross Blue Shield	$63 - $156	71%
Keystone Health Plan	$63 - $97	71%
Premier Comp Solutions	$74	83%
Prime Net	$76 - $236	85%
Upmc Work Partners	$77	87%
Aetna	$79 - $231	89%
Upmc Health Plan	$103	116%
Intergroup	$204 - $267	229%
Wellspan Population Health	$267	300%

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 $188.
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 UPMC Pinnacle Hospitals 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.