CMS Price Transparency Data

X-ray, shoulder

Facility: Cook Childrens Medical Center Prosper

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $203
Cash Discount Price: $412
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Cook Childrens Medical Center Prosper is $203. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $412. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.28x the Medicare baseline. Located in 4100 W University Drive, Prosper, TX.

Cash / Self-Pay

$412

Average discount available for prompt cash payment at this facility.

Insurance Median

$203

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: $412 (463%)

Insurance Median: $203 (228%)

Cash: $412 (463% of Medicare)

Ins. Median: $203 (228% 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 228% of the Medicare baseline (a markup of 128%). 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
Aetna	$31 - $467	35%
Beacon	$109 - $297	123%
El Paso Health First	$109 - $297	123%
Health Plan W. Uhrip	$109	123%
Health Plan W/O Uhrip	$109 - $297	123%
Tx Children Health	$109 - $297	123%
Wellpoint	$115	129%
Blue Cross Blue Shield	$118 - $494	133%
Superior Health	$118	133%
Firstcare	$120 - $439	135%
United Community	$120 - $203	135%
UnitedHealthcare	$242 - $467	272%
S&W Health	$461	519%
Cigna	$467	525%
Healthscope	$467	525%
Imagine Health	$467	525%
Humana	$478 - $483	538%
Multiplan	$478	538%
First Health	$483	543%
Galaxy Health	$494	556%
Healthsmart	$494	556%
Usamco	$505	568%

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 $412.
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 Cook Childrens Medical Center Prosper 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.