CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Valley West Community Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $3,511
Cash Discount Price: $3,835
vs. Medicare Baseline: 14.40x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Valley West Community Hospital is $3,511. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,835. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 14.40x the Medicare baseline. Located in 11 East Pleasant Avenue, Sandwich, IL.

Cash / Self-Pay

$3,835

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,511

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: $3,835 (1573%)

Insurance Median: $3,511 (1440%)

Cash: $3,835 (1573% of Medicare)

Ins. Median: $3,511 (1440% 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 1440% of the Medicare baseline (a markup of 1340%). 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
Blue Cross Blue Shield	$1,041 - $4,476	427%
Global Excel [1712]	$1,041	427%
Humana	$1,041	427%
Aetna	$1,392 - $3,797	571%
Health'S Finest Network [126]	$2,466 - $4,657	1012%
The Alliance [1703]	$2,978	1222%
Choicecare [177]	$3,693	1515%
Healthlink [125]	$4,109	1686%
Multiplan/Phcs [142]	$4,383 - $5,479	1798%
First Health Plan [6034]	$5,479	2248%
UnitedHealthcare	$5,479	2248%

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 $3,835.
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 Valley West Community 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.