CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Clarion Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $535
Cash Discount Price: $1,408
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Clarion Hospital is $535. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,408. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.19x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$1,408

Average discount available for prompt cash payment at this facility.

Insurance Median

$535

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: $1,408 (578%)

Insurance Median: $535 (219%)

Cash: $1,408 (578% of Medicare)

Ins. Median: $535 (219% 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 219% of the Medicare baseline (a markup of 119%). 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
Highmark	$230 - $855	94%
Highmark Community Blue	$232	95%
Amerihealth	$233	96%
Cigna	$233 - $1,257	96%
Martin'S Point - Usfhp	$233 - $880	96%
Medicare (plans)	$233	96%
Tricare	$233	96%
UnitedHealthcare	$233	96%
Aetna	$240 - $2,237	98%
Geisinger	$244	100%
Devoted Health Plan	$246 - $1,006	101%
The Health Plan	$246 - $546	101%
Gateway	$249 - $930	102%
Pa Health & Wellness	$249	102%
American Health Plan	$256	105%
Upmc	$258 - $1,320	106%
Highmark - Ind.& Managed Care	$522 - $855	214%
Peak Health	$546 - $1,760	224%
Workers Comp	$1,127	462%
Devon	$1,886	774%

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 $1,408.
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 Clarion 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.