CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Scripps Memorial Hospital - Encinitas

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $613
Cash Discount Price: $1,301
vs. Medicare Baseline: 2.51x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Scripps Memorial Hospital - Encinitas is $613. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,301. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.51x the Medicare baseline. Located in 354 Santa Fe Drive, Encinitas, CA.

Cash / Self-Pay

$1,301

Average discount available for prompt cash payment at this facility.

Insurance Median

$613

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$243.77

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $243.77 (100%)

Cash / Self-Pay: $1,301 (534%)

Insurance Median: $613 (251%)

Cash: $1,301 (534% of Medicare)

Ins. Median: $613 (251% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $243.77 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 251% of the Medicare baseline (a markup of 151%). 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
Mpmg Mcr Adv [836]	$132	54%
Mpmg [800]	$132	54%
Ocn Mcr Adv [890]	$132	54%
UnitedHealthcare	$132 - $1,259	54%
Aetna	$169 - $1,339	69%
Blue Cross Blue Shield	$265 - $1,259	109%
Cigna	$265 - $530	109%
Mc Alignment [917]	$265 - $530	109%
Mc Blue Shield Promise Health Plan [914]	$265 - $530	109%
Mc Blue Shield [902]	$265 - $530	109%
Mc Health Net [904]	$265 - $530	109%
Mc Scan [905]	$265 - $530	109%
Mc United [906]	$265 - $530	109%
Radys Cpmg [803]	$302 - $530	124%
Astiva Mcr Adv [464]	$307	126%
Bc Mcr Adv [830]	$307	126%
Bs Mcr Adv [829]	$307	126%
Central Health Mcr Adv [441]	$307	126%
Clever Care Mcr Adv [465]	$307	126%
D-Snp Mcr Adv [889]	$307	126%
Dsnp/Csnp - Generic [458]	$307	126%
Family Health Centers Pace Mcr Adv Hmo [556]	$307	126%
Family Health Centers Pace Medi-Cal [555]	$307	126%
Gary And Mary West Pace Medi-Cal Hmo [557]	$307	126%
Gpmg/Altura - Mcr Adv [888]	$307	126%
Hn Mcr Adv [832]	$307	126%
Humana	$307	126%
Integrated Health Partners - Mcr Adv [895]	$307	126%
Kaiser Northern Ca Region Mcr Adv [386]	$307	126%
La Care Mcr Adv Hmo [612]	$307	126%
Medicare (plans)	$307	126%
San Diego Pace Medi-Cal [553]	$307	126%
Scan Mcr Adv [835]	$307	126%
Scan [500]	$307	126%
Scan [818]	$307	126%
Sharp Comm Med Grp Mcr Adv [840]	$307	126%
Sharp Health Plan Mcr Adv [531]	$307	126%
Sharp Health Plan Mcr Adv [897]	$307	126%
Sharp Rees Stealy Med Grp Mcr Adv [841]	$307	126%
St Paul'S Pace Medi-Cal [551]	$307	126%
Ucsd Mcr Adv [873]	$307	126%
Uh Mcr Adv [831]	$307	126%
Uh Palomar Health Mcr Adv [885]	$307	126%
Alignment Health Plan [443]	$316	130%
Sharp Comm Med Grp [812]	$347 - $1,339	142%
Sharp Rees Stealy Med Grp [811]	$347 - $1,339	142%
Ucsd [807]	$347 - $1,339	142%
Health Net [340]	$488 - $1,180	200%
Prime Healthcare [614]	$522	214%
Prospect Med Group [893]	$537	220%
Blue Shield [230]	$586 - $1,114	240%
Bs [816]	$613 - $1,114	251%
Imperial County Phys Med Group [855]	$613 - $1,147	251%
Bc [814]	$654 - $1,147	268%
Integrated Health Partners [894]	$654 - $1,147	268%
Perlman Med Group [899]	$654 - $1,147	268%
Hn [815]	$673 - $1,180	276%
Centivo [581]	$681 - $1,193	279%
Uh [819]	$718 - $1,259	295%
Palomar Health [892]	$764 - $1,339	313%
Veba Med Grp [813]	$764 - $1,339	313%
Rady Children'S Hospital [825]	$1,550 - $2,718	636%
Kaiser Northern Ca Region Hmo/Ppo [384]	$2,155 - $3,778	884%
Kaiser [380]	$2,155 - $3,778	884%
Kaiser [383]	$2,155 - $3,778	884%
Multi Plan Network [470]	$2,684 - $4,706	1101%
First Health Network [330]	$2,836 - $4,971	1163%
Pnoa [615]	$2,836 - $4,971	1163%
Choice Care Network [270]	$3,025 - $5,303	1241%
Healthsmart [350]	$3,025 - $5,303	1241%

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 $1,301.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 73721.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Scripps Memorial Hospital - Encinitas is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 73721.
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.