CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Nationwide Children's Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $959
Cash Discount Price: $2,367
vs. Medicare Baseline: 3.93x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Nationwide Children's Hospital is $959. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,367. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 3.93x the Medicare baseline. Located in 700 Children's Drive, Columbus, OH.

Cash / Self-Pay

$2,367

Average discount available for prompt cash payment at this facility.

Insurance Median

$959

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: $2,367 (971%)

Insurance Median: $959 (393%)

Cash: $2,367 (971% of Medicare)

Ins. Median: $959 (393% 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 393% of the Medicare baseline (a markup of 293%). 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	$72 - $2,498	30%
Caresource	$92 - $392	38%
Humana	$147 - $2,498	60%
UnitedHealthcare	$180 - $2,498	74%
Ohio Ppo Connect	$181 - $2,446	74%
Osu	$181 - $2,446	74%
Blue Cross Blue Shield	$198 - $2,472	81%
Tricare	$224	92%
Mmo	$230 - $2,472	94%
Cigna	$240 - $2,472	98%
Front Path Health Coalition	$240 - $2,472	98%
Ohc	$240 - $2,446	98%
Ohg	$240 - $2,367	98%
The Health Plan	$240 - $2,525	98%
Amerihealth	$392	161%
Bchp	$392	161%
Molina	$392	161%
Ahpo	$2,472	1014%
Unicare	$2,498	1025%
Emerald Health	$2,577	1057%
First Health	$2,577	1057%
Phcs	$2,577	1057%

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 $2,367.
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 Nationwide Children's 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.