CMS Price Transparency Data

X-ray, shoulder

Facility: Margaretville Memorial Hospital

Billing Code: 73030 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73030
Insurance Median: $281
Cash Discount Price: $432
vs. Medicare Baseline: 3.16x Medicare

The contracted insurance negotiated median rate for a X-ray, shoulder at Margaretville Memorial Hospital is $281. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $432. Compared to the federal Medicare reimbursement reference rate of $88.91, this hospital’s rate is 3.16x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$432

Average discount available for prompt cash payment at this facility.

Insurance Median

$281

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: $432 (486%)

Insurance Median: $281 (316%)

Cash: $432 (486% of Medicare)

Ins. Median: $281 (316% 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 316% of the Medicare baseline (a markup of 216%). 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	$79 - $648	89%
Mvp	$108	121%
Emblem	$110 - $129	124%
Blue Cross Blue Shield	$113 - $285	127%
UnitedHealthcare	$128 - $285	144%
Mvp Hmo/Ppo	$128	144%
Oxford Exchange	$128	144%
Oxford	$128	144%
Self-Pay	$162	182%
Hamaspik (McR)	$190 - $285	214%
Mvp Gold (McR)	$190 - $285	214%
Medicare (plans)	$190 - $428	214%
Affinity By Molina McR	$200 - $299	225%
Cdphp	$209 - $314	235%
Emblem Ghi/Hip Ppo/Cbp	$268 - $402	301%
Mvp Exchange	$281 - $421	316%
Emblem Select Care (Exchange)	$294 - $441	331%
Magnacare Standard	$302 - $454	340%
Todays Options	$314 - $470	353%
Magnacare Preferred	$346 - $518	389%
Emblem Ghi/Hip Hmo/Epo/Pos	$346 - $518	389%
Multiplan	$354 - $531	398%
First Health	$389 - $583	438%

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 $432.
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 Margaretville 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.