CMS Price Transparency Data

MRI, knee or other leg joint

Facility: St Mary Medical Center

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $561
Cash Discount Price: $2,679
vs. Medicare Baseline: 2.30x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at St Mary Medical Center is $561. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,679. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.30x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.

Cash / Self-Pay

$2,679

Average discount available for prompt cash payment at this facility.

Insurance Median

$561

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: $2,679 (1099%)

Insurance Median: $561 (230%)

Cash: $2,679 (1099% of Medicare)

Ins. Median: $561 (230% 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 230% of the Medicare baseline (a markup of 130%). 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
Medicaid / KanCare	$206 - $795	85%
Blue Cross Blue Shield	$257	105%
Cigna	$260 - $1,633	107%
Align Senior Care	$262	107%
Medicare (plans)	$264 - $463	108%
Aetna	$272 - $1,963	112%
Health America Advantra	$309	127%
Pace-Trinity Health	$363 - $544	149%
UnitedHealthcare	$442 - $2,394	181%
Ambetter / Centene	$459	188%
Oscar	$463	190%
Prime Healthcare	$463	190%
Jefferson Health Plan Commercial	$468	192%
Homestead Health Plans Woods Center	$502	206%
Group Pension Administrators	$579	238%
Reedman Toll	$579	238%
Blue Shield - Pa (Highmark)	$696	286%
Keystone First	$795	326%
Keystone First Chip	$795	326%
Geha	$1,345 - $2,018	552%
Upmc Health Plan	$1,633	670%
Webtpa	$1,633	670%
Meritain	$1,963	805%
Multiplan	$2,967 - $4,451	1217%
Prime Health Services	$2,967 - $4,451	1217%
Galaxy Health Network	$3,132 - $4,699	1285%
Three Rivers Provider Network	$3,132 - $4,699	1285%

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 $2,679.
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 St Mary 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.