CMS Price Transparency Data

MRI, knee or other leg joint

Facility: HSHS St Elizabeth's Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $3,826
Cash Discount Price: $3,465
vs. Medicare Baseline: 15.70x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at HSHS St Elizabeth's Hospital is $3,826. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,465. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 15.70x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.

Cash / Self-Pay

$3,465

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,826

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: $3,465 (1421%)

Insurance Median: $3,826 (1570%)

Cash: $3,465 (1421% of Medicare)

Ins. Median: $3,826 (1570% 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 1570% of the Medicare baseline (a markup of 1470%). 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
Molina Healthcare	$220 - $282	90%
Meridian Health Plan	$230	94%
Aetna	$270 - $3,388	111%
Blue Cross Blue Shield	$270 - $4,813	111%
Clear Spring Health Of Illinois	$270	111%
Health Alliance Medical Plans	$270 - $4,091	111%
Health Partners	$270	111%
Humana	$270	111%
Sae Hospice	$270	111%
UnitedHealthcare	$270 - $4,813	111%
Celtic Insurance Company	$539	221%
Naphcare	$585	240%
Hopetrust	$648	266%
Claim Doc	$675	277%
Amish Community	$1,348	553%
Cigna	$2,862 - $4,813	1174%
Wellfirst	$3,099	1271%
First Health	$3,581	1469%
Healthlink	$3,826 - $4,813	1570%
Caterpillar, Inc.	$3,865	1586%
Consociate Group	$4,235	1737%
Choicecare	$4,332	1777%
Healthcare Finest Network (Hfn)	$4,332	1777%
Multiplan/Phcs	$4,332	1777%
Provider Network Of America	$4,332	1777%
City Of Springfield	$4,813	1974%
Current Health Solutions	$4,813	1974%
Healthscope	$4,813	1974%
Illinois Breast And Cervical Cancer Program	$4,813	1974%
Interplan	$4,813	1974%
Live360	$4,813	1974%
Wexford	$4,813	1974%

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 $3,465.
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 HSHS St Elizabeth's 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.