CMS Price Transparency Data

X-ray, shoulder

Facility: Children's Hospital of Philadelphia

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $488
Cash Discount Price: $1,160
vs. Medicare Baseline: 5.49x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Children's Hospital of Philadelphia is $488. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,160. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 5.49x the Medicare baseline. Located in 3401 Civic Center Blvd, Philadelphia, PA.

Cash / Self-Pay

$1,160

Average discount available for prompt cash payment at this facility.

Insurance Median

$488

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: $1,160 (1305%)

Insurance Median: $488 (549%)

Cash: $1,160 (1305% of Medicare)

Ins. Median: $488 (549% 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 549% of the Medicare baseline (a markup of 449%). 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
Geisinger Medical Assistance	$22	25%
Highmark Wholecare	$25	28%
Horizon Nj Health	$60	67%
Medicaid / KanCare	$191	215%
UnitedHealthcare	$193 - $638	217%
Health Partners	$219	246%
Aetna	$305 - $580	343%
Upmc Medical Assistance	$317	357%
Keystone First Chip	$360	405%
Keystone Health Plan East	$367	413%
Blue Cross Blue Shield	$410 - $465	461%
Geisinger Health Plan Commercial	$511	575%
Jefferson Health Plans	$549	617%
Cigna	$580	652%
Highmark	$580	652%
Qualcare	$638	718%
First Health Network	$754	848%
Devon Health, Intergroup, Multiplan, Valley Preferred/Populytics	$928	1044%
Private Health Care Systems	$928	1044%
Choice Care Network	$1,044	1174%

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 $1,160.
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 Children's Hospital of Philadelphia 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.