CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Prisma Health Hillcrest Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 73721
  • Insurance Median: $675
  • Cash Discount Price: $2,239
  • vs. Medicare Baseline: 2.77x Medicare
The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Prisma Health Hillcrest Hospital is $675. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,239. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.77x the Medicare baseline. Located in 741 South East Main Street, Simpsonville, SC.
Cash / Self-Pay
$2,239

Average discount available for prompt cash payment at this facility.

Insurance Median
$675

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: $2,239 (918%)
Insurance Median: $675 (277%)
Cash: $2,239 (918% of Medicare)
Ins. Median: $675 (277% 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 277% of the Medicare baseline (a markup of 177%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Tricare $225 92%
Blue Cross Blue Shield $227 - $1,513 93%
Champva [3049] $227 93%
Cigna $227 - $2,688 93%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904] $227 93%
Deseret Mutual Ins Co [3066] $227 93%
Generic Skilled Nursing [3196] $227 93%
Hospice Contracted [1500] $227 93%
Hospice Non Contracted [3190] $227 93%
Medicare (plans) $227 - $744 93%
Triwest Healthcare Alliance Vcp [902] $227 93%
Va Community Care Network-Vaccn [903] $227 93%
Veterans Administration [3194] $227 93%
Humana $229 - $796 94%
UnitedHealthcare $235 - $1,157 96%
Aetna $239 - $2,721 98%
Healthy Conn Prime-Wellcare Prime By Atc [5310] $239 98%
Healthy Conn Prime-First Choice Vip Care [5300] $241 99%
Healthy Conn Prime-Molina Healthcare [5330] $250 103%
Workers Comp [600] $318 130%
Ambetter / Centene $418 171%
Medicaid / KanCare $530 - $781 217%
Sc Dept Of Corrections [2998] $622 255%
Scdc-Sc Dept Of Corrections [7232] $622 255%
First Choice Benefits Mgmt [3074] $744 305%
Prisma Health Seniorcare Pace - Midlands [5400] $799 328%
Prisma Health Seniorcare Pace-Upstate [5200] $799 328%
Bluechoice [810] $867 - $1,597 356%
Golden Rule Insurance Company [2991] $1,157 475%
Oxford Health Plans [2992] $1,157 475%
Zzumr-Salt Lake City Ut [3169] $1,157 475%
Bob Jones Univ-Pai [821] $1,195 490%
Promise Health Plan Contracted [2401] $1,205 - $2,150 494%
Orangeburg Senior Helping Center Pace [5401] $1,378 565%
Planned Administrators [820] $1,513 621%
Meritain Health Contracted [2200] $2,204 - $2,721 904%
Preferred Administrators Contracted [2839] $2,411 989%
Medcost [2940] $2,549 - $2,859 1046%
Atlantic Packaging Contracted [4833] $2,583 1060%
Evernorth Behavioral Contracted [2982] $2,688 1103%
Mvp Health Care [3037] $2,688 1103%
Aps Healthcare System [2981] $2,755 1130%
Multiplan/Phcs Contracted [2950] $3,065 1257%
Vsp Vision Care [2986] $3,100 1272%
First Health Contracted [2952] $3,203 1314%
Furman Int/Allen University Student [2951] $3,203 1314%
Quiktrip-First Health [3067] $3,203 1314%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 741 South East Main Street, Simpsonville, SC 29681
  • CMS Rating: ★★★★☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals