CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Southcoast Hospitals Group

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $321
Cash Discount Price: $1,642
vs. Medicare Baseline: 1.32x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Southcoast Hospitals Group is $321. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,642. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.32x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$1,642

Average discount available for prompt cash payment at this facility.

Insurance Median

$321

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: $1,642 (674%)

Insurance Median: $321 (132%)

Cash: $1,642 (674% of Medicare)

Ins. Median: $321 (132% 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.

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
Medicare (plans)	$205 - $344	84%
Wellsense Health Plan [1010202]	$237	97%
Blue Cross Blue Shield	$262 - $640	107%
Tufts Health Public Plans [1010213]	$273 - $412	112%
Aetna	$287 - $2,499	118%
Evercare [1010304]	$287	118%
Tufts Senior Care Options [1010315]	$287	118%
UnitedHealthcare	$287 - $374	118%
Wellsense Health Plan Senior Care Options [1020208	$290	119%
Commonwealth Care Alliance [1080501]	$296 - $299	121%
Eternal Health [1010322]	$316	130%
Fallon [1000114]	$402	165%
Harvard Pilgrim [1010602]	$438	180%
Wellsense Health Plan Clarity Connectorcare & Meta	$702	288%
Cigna	$853	350%
Wellpoint [1000102]	$914	375%
Tufts [1010701]	$1,373	563%
Mass General Brigham Health Plan Commercial [10122	$1,850	759%
Mass General Brigham Health Plan Connectorcare [10	$1,850	759%
Group Insurance Service Center [1013001]	$1,970	808%
Innovative Health Plan [1025001]	$1,970	808%
Priority Health [1015001]	$1,970	808%
PHCS [1000125]	$2,135	876%
First Health [1000130]	$2,499	1025%

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 $1,642.
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 Southcoast Hospitals Group 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.