CMS Price Transparency Data

X-ray, shoulder

Facility: Stoughton Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $243
Cash Discount Price: $273
vs. Medicare Baseline: 2.73x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Stoughton Hospital is $243. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $273. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 2.73x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$273

Average discount available for prompt cash payment at this facility.

Insurance Median

$243

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: $273 (307%)

Insurance Median: $243 (273%)

Cash: $273 (307% of Medicare)

Ins. Median: $243 (273% 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 273% of the Medicare baseline (a markup of 173%). 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
Medicaid / KanCare	$67	75%
Tricare	$118	133%
Healthnet Mcr Adv - All Plans	$132	148%
Dean Health Insurance Med Adv	$139	156%
Humana	$139 - $446	156%
Quartz Mcr Adv	$139	156%
Security Health/First Health - All Plans	$139	156%
Aetna	$149 - $422	168%
UnitedHealthcare	$218 - $397	245%
Quartz Health Solutions - All Other Lans	$228	256%
Dean Health Insurance Comm - All Other Plans	$243	273%
Dean Health Insurance Epo	$243	273%
Geha - All Plans	$372	418%
Cigna	$397	447%
Wisconsin Ppo Ppa Direct - All Plans	$397	447%
Blue Cross Blue Shield	$432	486%
Wps - All Plans	$446	502%
Alliance - All Plans	$1,984	2231%

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 $273.
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 Stoughton 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.