CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Ellenville Regional Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $809
Cash Discount Price: $929
vs. Medicare Baseline: 3.32x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Ellenville Regional Hospital is $809. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $929. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.32x the Medicare baseline. Located in 10 Healthy Way, Ellenville, NY.

Cash / Self-Pay

$929

Average discount available for prompt cash payment at this facility.

Insurance Median

$809

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: $929 (381%)

Insurance Median: $809 (332%)

Cash: $929 (381% of Medicare)

Ins. Median: $809 (332% 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 332% of the Medicare baseline (a markup of 232%). 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
UnitedHealthcare	$30 - $2,328	12%
Emblemhealth	$68 - $1,822	28%
Cdphp	$74 - $843	30%
Blue Cross Blue Shield	$80 - $911	33%
Fidelis	$80 - $911	33%
Hamaspik Choice	$80 - $911	33%
Humana	$80 - $911	33%
Mvp Health Care Of Ny	$84 - $1,334	34%
Aetna	$92 - $1,750	38%
Local 1199Seiu	$92 - $1,750	38%
Wellcare	$109 - $1,253	45%
Galaxy Health	$129 - $1,481	53%
Oxford Health Plans	$2,328	955%

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 $929.
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 Ellenville Regional 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.