CMS Price Transparency Data

X-ray, shoulder

Facility: UPMC Horizon

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $290
Cash Discount Price: $445
vs. Medicare Baseline: 3.26x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at UPMC Horizon is $290. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $445. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 3.26x the Medicare baseline. Located in 110 North Main Street, Greenville, PA.

Cash / Self-Pay

$445

Average discount available for prompt cash payment at this facility.

Insurance Median

$290

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: $445 (501%)

Insurance Median: $290 (326%)

Cash: $445 (501% of Medicare)

Ins. Median: $290 (326% 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 326% of the Medicare baseline (a markup of 226%). 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
Upmc Health Plan	$29 - $103	33%
Blue Cross Blue Shield	$69 - $370	78%
Upmc Work Partners	$73	82%
Aetna	$86 - $445	97%
UnitedHealthcare	$88 - $296	99%
Amerihealth Caritas	$91	102%
Cigna	$91 - $296	102%
Highmark Wholecare (Prev Gateway)	$91 - $370	102%
Pa Health & Wellness	$91 - $408	102%
Geisinger	$408	459%
Intergroup	$482	542%
Coventry/First Health	$489	550%
Health Coalition Partners	$519	584%
Private Health Care Systems	$593	667%
Prime Net	$608	684%
Humana	$630	709%

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 $445.
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 Horizon 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.