CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Boone County Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $2,297
Cash Discount Price: $3,361
vs. Medicare Baseline: 9.42x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Boone County Hospital is $2,297. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,361. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 9.42x the Medicare baseline. Located in 1015 Union Street, Boone, IA.

Cash / Self-Pay

$3,361

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,297

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: $3,361 (1379%)

Insurance Median: $2,297 (942%)

Cash: $3,361 (1379% of Medicare)

Ins. Median: $2,297 (942% 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 942% of the Medicare baseline (a markup of 842%). 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
Tricare	$244	100%
Wellmark Hmo	$789	324%
Wellmark Ppo - All Other Plans	$866	355%
Choice Care Mcr Adv - All Plans	$1,148 - $2,297	471%
Humana	$1,148 - $5,042	471%
Iowa Hlth Adv - All Plans	$1,148 - $2,297	471%
Mt Carmel Hp - All Plans	$1,148 - $2,297	471%
UnitedHealthcare	$1,148 - $3,288	471%
Va Ccn-All Plans	$1,148 - $2,297	471%
Amerigroup Mcr Adv - All Other Plans	$1,160 - $2,320	476%
Aetna	$1,174 - $4,370	482%
Meridian Mcaid - All Plans	$1,260 - $2,521	517%
Iowa Total Care Mcaid - All Plans	$1,286 - $2,571	528%
Medicaid / KanCare	$1,298 - $2,597	532%
Healthsmart Accell Network	$1,961 - $3,921	804%
Medical Associates Hp-All Plans	$2,101 - $4,201	862%
Healthsmart Ppo - All Other Plans	$2,241 - $4,482	919%
Health Alliance-All Plans	$2,521 - $5,042	1034%
Midlands Choice-All Plans	$2,577 - $5,154	1057%
Mutually Preferred-All Plans	$2,661 - $5,322	1092%

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 $3,361.
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 Boone 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.