CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Nemours Children's Hospital, Delaware

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $660
Cash Discount Price: $1,158
vs. Medicare Baseline: 2.71x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Nemours Children's Hospital, Delaware is $660. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,158. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.71x the Medicare baseline. Located in 1600 Rockland Rd Po Box 269, Wilmington, DE.

Cash / Self-Pay

$1,158

Average discount available for prompt cash payment at this facility.

Insurance Median

$660

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: $1,158 (475%)

Insurance Median: $660 (271%)

Cash: $1,158 (475% of Medicare)

Ins. Median: $660 (271% 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 271% of the Medicare baseline (a markup of 171%). 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
Us Family Health Plan	$80	33%
Keystone First Hlth Plan	$231 - $512	95%
Tricare	$253	104%
Celtic Transplant	$349 - $1,158	143%
Celtic Transplant For De First Health	$405	166%
UnitedHealthcare	$425 - $723	174%
Wellpoint Maryland	$428	176%
Kidz Partners	$438	180%
Health Partners	$449	184%
Upmc	$459	188%
Fidelis	$463	190%
Aetna	$491 - $672	201%
Blue Cross Blue Shield	$508 - $1,023	208%
Priority Partners John Hopkins	$568	233%
Six Degrees Health Transplant	$579	238%
Cigna	$637 - $730	261%
Great West-One Health Plan	$637 - $730	261%
Ambetter / Centene	$660	271%
Amerihealth Caritas Delaware	$660	271%
Geisinger Health Plan	$695	285%
Integra Administrative Group	$695	285%
National Transplant Network (Ntn)	$753	309%
Six Degrees Health	$753	309%
Star Healthcare Network	$753	309%
Life Trac Solid Organ And Bmt Transplant	$811	333%
First Health Network	$1,100	451%
Insurance Administrators Of America	$1,100	451%
Interlink Transplant Network	$1,100	451%
Multiplan	$1,100	451%
Preferred Healthcare	$1,100	451%
Private Healthcare Systems	$1,100	451%
Three Rivers Provider Network	$1,100	451%

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 $1,158.
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 Nemours Children's Hospital, Delaware 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.