CMS Price Transparency Data
MRI, knee or other leg joint
Facility: Saint Joseph Regional Medical Center - Plymouth
Billing Code: 73721 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 73721
- Insurance Median: $3,770
- Cash Discount Price: $3,713
- vs. Medicare Baseline: 15.47x Medicare
The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Saint Joseph Regional Medical Center - Plymouth is $3,770. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,713. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 15.47x the Medicare baseline. Located in 1915 Lake Ave, Plymouth, IN.
Cash / Self-Pay
$3,713
Average discount available for prompt cash payment at this facility.
Insurance Median
$3,770
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: $3,713 (1523%)
Insurance Median: $3,770 (1547%)
Cash: $3,713 (1523% of Medicare)
Ins. Median: $3,770 (1547% 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 1547% of the Medicare baseline (a markup of 1447%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Aetna | $131 - $4,455 | 54% |
| Blue Cross Blue Shield | $131 - $891 | 54% |
| Medicaid / KanCare | $131 - $505 | 54% |
| UnitedHealthcare | $131 - $1,056 | 54% |
| Medicare (plans) | $252 - $257 | 103% |
| Meridian Complete | $252 | 103% |
| Pace-Trinity Health | $252 | 103% |
| County Coroner | $263 | 108% |
| Provider Partners Health Plan Of Indiana | $278 | 114% |
| Auxiant | $379 - $5,689 | 155% |
| Physicians Health Plan Northern Indiana Health Insurance | $379 - $762 | 155% |
| St Joseph County Hlth Dpt | $379 | 155% |
| Caresource | $391 | 160% |
| Siho Insurance Services | $404 | 166% |
| Key Benefit Administrator | $454 - $4,806 | 186% |
| Allied Benefit Systems | $480 - $4,455 | 197% |
| Managed Health Services - Indiana | $505 | 207% |
| Mdwise | $505 | 207% |
| Custom Design Benefits | $543 | 223% |
| Blue Benefit Administrators Of Massachusetts | $891 | 366% |
| Blue Care Network | $891 | 366% |
| Blue Distinction Transplant | $891 | 366% |
| Blue Shield - Ca | $891 | 366% |
| Blue Shield - Id (Regence) | $891 | 366% |
| Blue Shield - Ny Highmark Northeastern | $891 | 366% |
| Blue Shield - Ny Highmark Western | $891 | 366% |
| Blue Shield - Pa (Highmark) | $891 | 366% |
| Blue Shield - Wa (Regence) | $891 | 366% |
| Geha | $1,056 | 433% |
| Healthscope | $1,056 | 433% |
| Student Insurance Cma | $1,056 | 433% |
| 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% |
| Ameriben | $2,742 - $4,112 | 1125% |
| Asr Health Benefits | $2,970 - $4,455 | 1218% |
| Christian Brother Services | $2,970 - $4,455 | 1218% |
| Employee Benefit Management | $2,970 - $4,455 | 1218% |
| Medical Mutual | $2,970 - $4,455 | 1218% |
| Meritain | $2,970 - $4,455 | 1218% |
| Preferred One | $2,970 - $4,455 | 1218% |
| Rural Carrier Health Benefit Plan | $2,970 - $4,455 | 1218% |
| Webtpa | $2,970 - $4,455 | 1218% |
| Encore Health | $3,204 - $4,806 | 1314% |
| Indiana Criminal Justice Inst | $3,204 - $4,806 | 1314% |
| Western & Southern Financial Group | $3,204 - $4,806 | 1314% |
| Cigna | $3,290 - $4,935 | 1350% |
| Group Administrators | $3,290 - $4,935 | 1350% |
| Health Partners | $3,290 - $4,935 | 1350% |
| Mvp | $3,290 - $4,935 | 1350% |
| Prairie States | $3,290 - $4,935 | 1350% |
| Priority Health | $3,290 - $4,935 | 1350% |
| Professional Benefit Administrators | $3,290 - $4,935 | 1350% |
| Sagamore Health Network | $3,290 - $5,278 | 1350% |
| Sisco Benefits | $3,290 - $4,935 | 1350% |
| Unified Group Services | $3,290 - $4,935 | 1350% |
| Goshen Preferred Network | $3,519 - $5,894 | 1444% |
| Signature Care | $3,793 - $5,689 | 1556% |
| Allied National Global Care | $4,113 - $6,169 | 1687% |
| Asrm - Reliance Standard Life Insurance | $4,113 - $6,169 | 1687% |
| Avmed Health Plan | $4,113 - $6,169 | 1687% |
| Christian Care Ministry | $4,113 - $6,169 | 1687% |
| Dean Health | $4,113 - $6,169 | 1687% |
| Fallon Health | $4,113 - $6,169 | 1687% |
| Family Life Insurance Company | $4,113 - $6,169 | 1687% |
| Freedom Life Insurance Company | $4,113 - $6,169 | 1687% |
| Ghc Scw | $4,113 - $6,169 | 1687% |
| International Benefit Administrators | $4,113 - $6,169 | 1687% |
| Lifetime Benefit Solutions | $4,113 - $6,169 | 1687% |
| Manhattan Life | $4,113 - $6,169 | 1687% |
| Medi Share | $4,113 - $6,169 | 1687% |
| Multiplan | $4,113 - $6,169 | 1687% |
| Pai | $4,113 - $6,169 | 1687% |
| Pan-American Life | $4,113 - $6,169 | 1687% |
| Paramount Hmo | $4,113 - $6,169 | 1687% |
| Phcs | $4,113 - $6,169 | 1687% |
| Philadelphia American Life Insurance | $4,113 - $6,169 | 1687% |
| Trinity Health Share | $4,113 - $6,169 | 1687% |
| Bankers Life Casualty | $4,570 - $6,854 | 1875% |
| Bureau Of Disability | $4,570 - $6,854 | 1875% |
| Wc Align Network | $4,570 - $6,854 | 1875% |