CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Southwest General Health Center

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,233
Cash Discount Price: $2,500
vs. Medicare Baseline: 5.06x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Southwest General Health Center is $1,233. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,500. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.06x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.

Cash / Self-Pay

$2,500

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,233

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: $2,500 (1026%)

Insurance Median: $1,233 (506%)

Cash: $2,500 (1026% of Medicare)

Ins. Median: $1,233 (506% 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 506% of the Medicare baseline (a markup of 406%). 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
Medical Mutual	$96 - $102	39%
Medical Mutual-Ohio	$96	39%
Amerihealth Caritas	$253	104%
Blue Cross Blue Shield	$253	104%
Buckeye	$253 - $303	104%
Caresource	$253	104%
Humana	$253 - $1,300	104%
Molina	$253 - $303	104%
UnitedHealthcare	$253 - $1,800	104%
Healthsmart	$1,067	438%
Health Design Plus	$1,233	506%
Clarity Health	$1,333	547%
Healthspan	$1,333	547%
Healthsmart Preferred	$1,500	615%
Ohio Health Choice Plus	$1,613	662%
Summacare	$1,800	738%
Aetna	$1,803	740%
Cigna	$1,823	748%
Coventry	$2,300	944%
First Health	$2,300	944%
Ohio Health Choice	$2,576	1057%
Private Healthare Systems	$2,666	1094%

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 $2,500.
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 Southwest General Health Center 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.