CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Saint Joseph Regional Medical Center

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 73721
  • Insurance Median: $891
  • Cash Discount Price: $4,455
  • vs. Medicare Baseline: 3.66x Medicare
The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Saint Joseph Regional Medical Center is $891. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,455. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.66x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$4,455

Average discount available for prompt cash payment at this facility.

Insurance Median
$891

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: $4,455 (1828%)
Insurance Median: $891 (366%)
Cash: $4,455 (1828% of Medicare)
Ins. Median: $891 (366% 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 366% of the Medicare baseline (a markup of 266%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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 $128 - $891 53%
Managed Health Services - Indiana $129 - $505 53%
Mdwise $129 - $505 53%
Medicaid / KanCare $129 - $505 53%
Aetna $131 - $4,455 54%
Medicare (plans) $131 - $257 54%
Meridian Complete $131 - $252 54%
Pace-Trinity Health $131 - $252 54%
UnitedHealthcare $131 - $2,221 54%
County Coroner $136 - $263 56%
Provider Partners Health Plan Of Indiana $144 - $278 59%
Geha $148 - $1,056 61%
Healthscope $148 - $1,056 61%
Student Insurance Cma $148 - $1,056 61%
Auxiant $196 - $5,689 80%
Physicians Health Plan Northern Indiana Health Insurance $196 - $762 80%
St Joseph County Hlth Dpt $196 - $379 80%
Caresource $203 - $391 83%
Siho Insurance Services $210 - $404 86%
Key Benefit Administrator $236 - $4,265 97%
Allied Benefit Systems $249 - $4,455 102%
Custom Design Benefits $282 - $543 116%
Blue Benefit Administrators Of Massachusetts $311 - $891 128%
Blue Care Network $311 - $891 128%
Blue Distinction Transplant $311 - $891 128%
Blue Shield - Ca $311 - $891 128%
Blue Shield - Id (Regence) $311 - $891 128%
Blue Shield - Ny Highmark Northeastern $311 - $891 128%
Blue Shield - Ny Highmark Western $311 - $891 128%
Blue Shield - Pa (Highmark) $311 - $891 128%
Blue Shield - Wa (Regence) $311 - $891 128%
Asr Health Benefits $974 - $4,455 400%
Christian Brother Services $974 - $4,455 400%
Employee Benefit Management $974 - $4,455 400%
Medical Mutual $974 - $4,455 400%
Meritain $974 - $4,455 400%
Preferred One $974 - $4,455 400%
Rural Carrier Health Benefit Plan $974 - $4,455 400%
Webtpa $974 - $4,455 400%
Hospice Of Marshall County $1,188 - $1,782 487%
Hospice Of St Joseph County $1,188 - $1,782 487%
Plain Church Group $1,234 - $1,851 506%
Notre Dame Athletic Association $2,514 - $3,770 1031%
Wc Notre Dame $2,514 - $3,770 1031%
Luminare Health (Detroit) $2,605 - $4,112 1069%
Encore Health $2,708 - $4,265 1111%
Ameriben $2,742 - $4,112 1125%
Indiana Criminal Justice Inst $2,843 - $4,265 1166%
Western & Southern Financial Group $2,843 - $4,265 1166%
Cigna $2,925 - $4,387 1200%
Group Administrators $2,925 - $4,387 1200%
Health Partners $2,925 - $4,387 1200%
Mvp $2,925 - $4,387 1200%
Prairie States $2,925 - $4,387 1200%
Priority Health $2,925 - $4,387 1200%
Professional Benefit Administrators $2,925 - $4,387 1200%
Sagamore Health Network $2,925 - $5,072 1200%
Sisco Benefits $2,925 - $4,387 1200%
Unified Group Services $2,925 - $4,387 1200%
Goshen Preferred Network $3,519 - $5,894 1444%
Christian Brothers Holy Cross $3,656 - $5,483 1500%
Signature Care $3,656 - $5,483 1500%
Bankers Life Casualty $4,570 - $6,854 1875%
Bureau Of Disability $4,570 - $6,854 1875%
Wc Align Network $4,570 - $6,854 1875%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 5215 Holy Cross Pkwy, Mishawaka, IN 46545
  • CMS Rating: ★★☆☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals