CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Major Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $2,510
Cash Discount Price: $1,118
vs. Medicare Baseline: 10.30x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Major Hospital is $2,510. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,118. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 10.30x the Medicare baseline. Located in 2451 Intelliplex Dr, Shelbyville, IN.

Cash / Self-Pay

$1,118

Average discount available for prompt cash payment at this facility.

Insurance Median

$2,510

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: $1,118 (459%)

Insurance Median: $2,510 (1030%)

Cash: $1,118 (459% of Medicare)

Ins. Median: $2,510 (1030% 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 1030% of the Medicare baseline (a markup of 930%). 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	$129 - $2,130	53%
Caresource Mrktplce -All Plans	$480	197%
Ambetter / Centene	$505	207%
Sho Direct-All Plans	$1,590 - $2,385	652%
UnitedHealthcare	$1,826 - $2,818	749%
Phcs - All Plans	$2,193 - $3,289	900%
Aetna	$2,423 - $3,636	994%
Siho-All Plans	$2,510 - $3,765	1030%
Humana	$2,601 - $3,902	1067%
First Health - All Plans	$2,712 - $4,068	1113%
Cigna	$2,856 - $4,285	1172%

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 $1,118.
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 Major 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.