CMS Price Transparency Data

X-ray, shoulder

Facility: Sanford Clear Lake Medical Center

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $377
Cash Discount Price: $366
vs. Medicare Baseline: 4.24x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Sanford Clear Lake Medical Center is $377. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $366. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 4.24x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$366

Average discount available for prompt cash payment at this facility.

Insurance Median

$377

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: $366 (412%)

Insurance Median: $377 (424%)

Cash: $366 (412% of Medicare)

Ins. Median: $377 (424% 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 424% of the Medicare baseline (a markup of 324%). 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
Sanford Health Plan Align	$234	263%
Security Health Plan	$251	282%
Ucare	$252 - $402	283%
Wellmark Sd	$252	283%
Aetna	$254 - $397	286%
Health Partners	$254 - $343	286%
Medicare (plans)	$254	286%
UnitedHealthcare	$254 - $382	286%
Primewest	$259	291%
Sanford Health Plan	$317 - $425	357%
Blue Cross Blue Shield	$374 - $423	421%
Medica	$377 - $403	424%
Wellmark	$393 - $398	442%
Cigna	$411	462%
First Choice Health Network	$411	462%
Healthez	$411	462%
Multiplan	$411	462%

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 $366.
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 Sanford Clear Lake Medical Center 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.