MRI, knee or other leg joint
Facility: Holton Community Hospital
Billing Code: 73721 (CPT)
- CPT Billing Code: 73721
- Insurance Median: $1,119
- Cash Discount Price: $1,219
- vs. Medicare Baseline: 4.59x 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 459% of the Medicare baseline (a markup of 359%). 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 | $521 | 214% |
| Aetna | $626 - $2,069 | 257% |
| UnitedHealthcare | $626 - $2,069 | 257% |
| Humana | $633 - $1,108 | 260% |
| Kansas Superior Select - All Plans | $639 - $1,118 | 262% |
| Preferred Health Professionals | $981 - $1,717 | 402% |
| Preferred Health Fn Select - All Other Plans | $981 - $1,717 | 402% |
| Preferred Health Freedom | $981 - $1,717 | 402% |
| Wppa Providers - All Plans | $1,123 - $1,966 | 461% |
| Medicaid / KanCare | $1,182 - $2,069 | 485% |
Consumer Guidance & Cost Commentary
For the MRI procedure of the knee or other leg joint at Holton Community Hospital in Holton, KS, the facility's cash median rate is $1,219, while the median negotiated rate for in-network insurance plans is $1,119. This specific service is priced at 4.6 times the Medicare benchmark amount of $243.77. While the cash price is higher than the negotiated rate, patients with high-deductible plans may find the cash option more affordable if their insurance allowed amount exceeds the cash price, as paying out-of-pocket can sometimes result in lower total costs than the insurance negotiated rate. It is important to note that commercial rates often include administrative overhead and contract dynamics that can inflate the baseline price compared to the true cost of care represented by Medicare benchmarks.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services like emergency physicians or labs are out-of-network. To avoid these surprises, consumers should request a full itemized CPT-coded bill before paying, as summary bills often obscure individual line items and potential errors such as code unbundling or services not rendered. Additionally, since hospitals frequently offer prompt-pay discounts of 20% to 50% for upfront payment, patients are encouraged to ask the billing department about self-pay or prompt-pay rates before scheduling to ensure they are not automatically enrolled in insurance processing that could void a cash discount agreement.