CMS Price Transparency Data

X-ray, shoulder

Facility: Forbes Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $32
Cash Discount Price: $425
vs. Medicare Baseline: 0.36x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Forbes Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $425. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 0.36x the Medicare baseline. Located in 2570 Haymaker Road, Monroeville, PA.

Cash / Self-Pay

$425

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $425 (478%)

Insurance Median: $32 (36%)

Cash: $425 (478% of Medicare)

Ins. Median: $32 (36% 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
Univera	$7 - $41	8%
Amerihealth	$9 - $89	10%
Highmark	$10 - $166	11%
Pennsylvania Health And Wellness	$11 - $37	12%
Geisinger	$12 - $40	13%
UnitedHealthcare	$12 - $268	13%
Cigna	$14 - $197	16%
Aetna	$20 - $241	22%
Highmark Wholecare	$23 - $90	26%
Martin'S Point	$73 - $85	82%
American Health Plans	$85	96%
Life Pittsburgh	$85	96%
Medicare (plans)	$87	98%
Humana	$90	101%
Molina	$92	103%
University Of Pittsburgh Medical Center	$182 - $274	205%
Medical Mutual	$247	278%

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 $425.
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 Forbes 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.