X-ray, shoulder
Facility: Regional Medical Center
Billing Code: 73030 (CPT)
- CPT Billing Code: 73030
- Insurance Median: $870
- Cash Discount Price: $354
- vs. Medicare Baseline: 9.79x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 979% of the Medicare baseline (a markup of 879%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 979% |
Consumer Guidance & Cost Commentary
Regional Medical Center in Manchester, IA, lists a cash price of $354 for an X-ray of the shoulder, which is significantly lower than the facility's negotiated rate of $870 and its gross charge of $442. While the facility is a Critical Access Hospital with a government-local ownership structure and holds a 4-star rating, the price transparency data indicates that cash payment could result in substantial savings compared to insurance billing. For patients with high-deductible plans, paying the cash price of $354 upfront may be more cost-effective than the insurance negotiated rate of $870, as commercial payer contracts often include administrative overhead that inflates the final bill.
The Medicare benchmark for this service is $88.91, which serves as a baseline for evaluating the facility's pricing markup. The 9.8x multiplier noted in the data highlights the disparity between the government's fixed reimbursement rate and the facility's commercial pricing, illustrating that the negotiated rate is substantially higher than the true cost of care. To minimize out-of-pocket expenses, patients should contact the facility directly to inquire about self-pay or prompt-pay discounts, which can further reduce the $354 cash price. It is also advisable to request an itemized bill before payment to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills typically contain errors that can be corrected through a formal audit dispute.