CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Stephens County Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $865
Cash Discount Price: $930
vs. Medicare Baseline: 3.55x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Stephens County Hospital is $865. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $930. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.55x the Medicare baseline. Located in 163 Hospital Drive, Toccoa, GA.

Cash / Self-Pay

$930

Average discount available for prompt cash payment at this facility.

Insurance Median

$865

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: $930 (382%)

Insurance Median: $865 (355%)

Cash: $930 (382% of Medicare)

Ins. Median: $865 (355% 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 355% of the Medicare baseline (a markup of 255%). 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
Caresource	$235	96%
Medicare (plans)	$235	96%
Amerigroup	$309 - $893	127%
Medicaid / KanCare	$309 - $920	127%
Blue Cross Blue Shield	$769 - $2,223	315%
Aetna	$817 - $2,361	335%
UnitedHealthcare	$846 - $2,444	347%
Cigna	$865 - $2,500	355%

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 $930.
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 Stephens County Hospital 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.