CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Down East Community Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,601
Cash Discount Price: $1,820
vs. Medicare Baseline: 6.57x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Down East Community Hospital is $1,601. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,820. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 6.57x the Medicare baseline. Located in 11 Hospital Drive, Machias, ME.

Cash / Self-Pay

$1,820

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,601

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: $1,820 (747%)

Insurance Median: $1,601 (657%)

Cash: $1,820 (747% of Medicare)

Ins. Median: $1,601 (657% 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 657% of the Medicare baseline (a markup of 557%). 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
Blue Cross Blue Shield	$252 - $2,937	103%
Humana	$252 - $1,601	103%
Wellcare	$252 - $1,601	103%
Partners Direct Health	$287 - $1,820	118%
Community Health Options	$474 - $3,013	194%
Aetna	$478 - $3,039	196%
UnitedHealthcare	$493 - $3,130	202%
Martins Point	$516 - $3,275	212%
Patients Advocates	$516 - $3,275	212%
Cigna	$517 - $3,282	212%
Harvard Pilgrim	$524 - $3,330	215%

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 $1,820.
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 Down East Community 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.