MRI, knee or other leg joint
Facility: Decatur Health
Billing Code: 73721 (CPT)
- CPT Billing Code: 73721
- Insurance Median: $851
- Cash Discount Price: $990
- vs. Medicare Baseline: 3.49x 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 349% of the Medicare baseline (a markup of 249%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $651 - $669 | 267% |
| UnitedHealthcare | $662 - $851 | 272% |
| Humana | $668 - $687 | 274% |
| Blue Cross Blue Shield | $678 | 278% |
| Midlands Choice- All Plans | $976 - $1,004 | 400% |
| Aetna | $976 - $1,115 | 400% |
| Medicaid / KanCare | $1,095 - $1,127 | 449% |
Consumer Guidance & Cost Commentary
For the MRI of a knee or other leg joint at Decatur Health in Oberlin, KS, the facility's cash price of $990 is lower than the median negotiated rates paid by major insurers like UnitedHealthcare ($851) and Aetna ($1,115). While the facility's cash rate is higher than the state average for this procedure, it remains significantly below the gross chargemaster price of $1,100. Patients with high-deductible plans may find paying out-of-pocket upfront more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price. To maximize savings, consumers should explicitly request self-pay or prompt-pay discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
The facility's allowed amount under Medicare is $243.77, which serves as a critical benchmark for evaluating commercial pricing. The median negotiated rate of $851 represents a substantial markup compared to the Medicare rate, reflecting the administrative costs and contract dynamics inherent in commercial insurance. Since the No Surprises Act prohibits balance billing for out-of-network providers at in-network facilities, patients should verify their network status and ensure no unexpected ancillary charges are applied. If a surprise bill arises, consumers should dispute it in writing with the insurer rather than paying immediately, and always request a detailed, itemized bill to identify any unbundled codes or services not rendered before finalizing payment.