MRI, knee or other leg joint
Facility: Nemaha Valley Community Hospital
Billing Code: 73721 (CPT)
- CPT Billing Code: 73721
- Insurance Median: $998
- Cash Discount Price: $1,790
- vs. Medicare Baseline: 4.09x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 409% of the Medicare baseline (a markup of 309%). 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.
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 | $553 | 227% |
| Humana | $875 | 359% |
| Va Ccn - All Plans | $875 | 359% |
| Aetna | $884 - $1,690 | 363% |
| Celtic Comm Exch - All Plans | $963 | 395% |
| Partners Direct Health - All Plans | $1,034 | 424% |
| Multiplan - All Plans | $1,790 | 734% |
| Midlands Choice - All Plans | $1,889 | 775% |
| Health Partners - All Plans | $1,889 | 775% |
Consumer Guidance & Cost Commentary
For the MRI of a knee or other leg joint (CPT 73721) at Nemaha Valley Community Hospital in Seneca, KS, the cash median price is $1,790, which aligns exactly with the facility's negotiated rate for Multiplan and Midlands Choice. This cash price is significantly higher than the Medicare benchmark of $243.77, reflecting a markup common in commercial pricing where negotiated rates often average 200% to 300% of the federal baseline. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial negotiated rates can sometimes exceed cash prices; however, in this specific case, the cash rate is the lowest available option compared to the various payer-specific negotiated amounts ranging from $553 to $1,889.
To minimize out-of-pocket costs, patients should proactively request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can bypass the administrative overhead and claims processing fees that inflate insurance bills. It is important to verify your deductible status before relying on insurance, as paying the full negotiated rate without meeting your plan's deductible can result in higher total costs than paying cash directly. Additionally, since the No Surprises Act prohibits balance billing for out-of-network services at in-network facilities, you can avoid unexpected charges by ensuring your provider is properly classified and by requesting a detailed, itemized bill to review for any unbundled codes or services not rendered.