CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Adena Pike Medical Center

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $3,064
Cash Discount Price: $2,116
vs. Medicare Baseline: 12.57x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Adena Pike Medical Center is $3,064. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,116. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 12.57x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$2,116

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,064

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: $2,116 (868%)

Insurance Median: $3,064 (1257%)

Cash: $2,116 (868% of Medicare)

Ins. Median: $3,064 (1257% 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 1257% of the Medicare baseline (a markup of 1157%). 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	$1,016 - $3,445	417%
Blue Cross Blue Shield	$1,016 - $3,652	417%
Buckeye Community Health Plan	$1,016	417%
Humana	$1,016 - $4,020	417%
Medical Mutual Of Ohio	$1,016 - $2,689	417%
Medigold	$1,016	417%
Molina	$1,016	417%
Care Source	$1,036	425%
Gateway Health	$1,397	573%
Molina Marketplace	$1,666	683%
Care Source Just4Me	$1,828	750%
First Health	$2,000 - $3,318	820%
Sidecar Health	$2,793	1146%
Ohio Ppo Connect	$2,962	1215%
The Health Plan	$2,962	1215%
Cigna	$3,064	1257%
Medical Mutual Of Ohio Supermed	$3,189	1308%
Ohio Health Choice	$3,369	1382%
UnitedHealthcare	$3,640	1493%
Integrated Health Plan	$3,978	1632%
Healthsmart	$4,020	1649%
Multiplan/Private Healthcare Systems	$4,020	1649%
Three Rivers Network	$4,020	1649%

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 $2,116.
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 Adena Pike Medical 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.