MRI, knee or other leg joint
Facility: Hiawatha Community Hospital
Billing Code: 73721 (CPT)
- CPT Billing Code: 73721
- Insurance Median: $2,255
- Cash Discount Price: $2,895
- vs. Medicare Baseline: 9.25x 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 925% of the Medicare baseline (a markup of 825%). 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 | $525 - $553 | 215% |
| Aetna | $1,071 - $2,339 | 439% |
| UnitedHealthcare | $1,071 - $2,487 | 439% |
| Humana | $1,082 | 444% |
| Ambetter / Centene | $1,285 | 527% |
| Centrus Health Direct - All Plans | $2,171 | 891% |
| Oscar - All Plans | $2,171 | 891% |
| Preferred Hlth - All Plans | $2,606 | 1069% |
| Wppa Providrs Care - All Plans | $2,750 | 1128% |
| Cigna | $2,750 | 1128% |
| Multiplan - All Plans | $2,808 | 1152% |
| Midlands Choice - All Plans | $2,808 | 1152% |
| Healthy Blue Mcaid - All Plans | $2,895 | 1188% |
Consumer Guidance & Cost Commentary
For CPT code 73721, an MRI of the knee or other leg joint, Hiawatha Community Hospital in Hiawatha, KS, lists a cash price of $2,895.00, which matches the facility's cash median. This rate is significantly higher than the state average, reflecting the typical markup found in Critical Access Hospitals. While commercial payers like Blue Cross Blue Shield and Aetna negotiate rates ranging from $525 to $2,487, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that commercial negotiated rates frequently include administrative overhead and do not represent the lowest possible cost, so patients should verify their specific plan's allowed amount before scheduling.
Patients should be aware that insurance billing can sometimes lead to balance billing if a provider bills the difference between their full chargemaster rate and the insurance allowed amount, though the No Surprises Act protects against this for emergency care and non-emergency services at in-network facilities. To avoid unexpected costs, consumers should request a full itemized bill to identify any errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain inaccuracies. Additionally, asking the hospital directly about self-pay or prompt-pay discounts before receiving an insurance bill can result in significant savings, as these upfront payment incentives bypass costly claims processing and administrative fees.