CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Middlesboro Arh Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,850
Cash Discount Price: $4,533
vs. Medicare Baseline: 7.59x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Middlesboro Arh Hospital is $1,850. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $4,533. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 7.59x the Medicare baseline. Located in 3600 West Cumberland Avenue, Middlesboro, KY.

Cash / Self-Pay

$4,533

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,850

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: $4,533 (1860%)

Insurance Median: $1,850 (759%)

Cash: $4,533 (1860% of Medicare)

Ins. Median: $1,850 (759% 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 759% of the Medicare baseline (a markup of 659%). 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
Aetna	$166 - $9,369	68%
Blue Cross Blue Shield	$166 - $1,850	68%
Humana	$166 - $1,850	68%
UnitedHealthcare	$166 - $7,505	68%
Wellcare Of Kentucky	$166 - $2,518	68%
Passport Molina	$925 - $1,850	379%
Caresoure Kentucky	$3,022 - $6,044	1240%

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 $4,533.
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 Middlesboro Arh 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.