CMS Price Transparency Data

X-ray, shoulder

Facility: Fort Memorial Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $34
Cash Discount Price: $128
vs. Medicare Baseline: 0.38x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Fort Memorial Hospital is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 0.38x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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: $128 (144%)

Insurance Median: $34 (38%)

Cash: $128 (144% of Medicare)

Ins. Median: $34 (38% 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
Blue Cross Blue Shield	$8 - $292	9%
Dean Health Plan	$8 - $363	9%
Humana	$8 - $318	9%
Mercycare	$8 - $331	9%
Molina	$8 - $85	9%
Quartz	$8 - $341	9%
UnitedHealthcare	$8 - $338	9%
Managed Health Services	$10 - $25	11%
Aetna	$14 - $334	16%
Alliance	$23 - $320	26%
Medicaid / KanCare	$23	26%
Centivo	$27 - $500	30%
Fort Care	$28 - $98	31%
Group Health Cooperative	$34 - $288	38%
Trilogy	$50 - $392	56%
Cigna	$54 - $423	61%
Medicare (plans)	$85	96%
Veteran Evaluation Services	$105	118%

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 $128.
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 Fort Memorial 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.