CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Prisma Health Tuomey Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 73721
  • Insurance Median: $622
  • Cash Discount Price: $2,239
  • vs. Medicare Baseline: 2.55x Medicare
The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Prisma Health Tuomey Hospital is $622. 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 2.55x the Medicare baseline. Located in 129 N Washington St, Sumter, SC.
Cash / Self-Pay
$2,239

Average discount available for prompt cash payment at this facility.

Insurance Median
$622

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: $622 (255%)
Cash: $2,239 (918% of Medicare)
Ins. Median: $622 (255% 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 255% of the Medicare baseline (a markup of 155%). 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
Blue Cross Blue Shield $223 - $1,879 91%
Cigna $223 - $2,365 91%
Covid19 Hrsa Uninsured Testing & Treatment Fund [904] $223 91%
Humana $223 - $2,583 91%
Medicare (plans) $223 - $234 91%
Triwest Healthcare Alliance Vcp [902] $223 91%
Va Community Care Network-Vaccn [903] $223 91%
Tricare $226 93%
UnitedHealthcare $231 - $530 95%
Aetna $234 - $2,721 96%
Healthy Conn Prime-First Choice Vip Care [5300] $234 96%
Healthy Conn Prime-Molina Healthcare [5330] $234 96%
Healthy Conn Prime-Wellcare Prime By Atc [5310] $234 96%
Workers Comp [600] $312 128%
Ambetter / Centene $410 168%
Bluechoice [810] $458 - $1,879 188%
Golden Rule Insurance Company [2991] $525 215%
Oxford Health Plans [2992] $525 215%
Zzumr-Salt Lake City Ut [3169] $525 215%
Medicaid / KanCare $530 - $763 217%
Scdc-Sc Dept Of Corrections [7232] $622 255%
Prisma Health Seniorcare Pace - Midlands [5400] $799 328%
Prisma Health Seniorcare Pace-Upstate [5200] $799 328%
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] $1,879 771%
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%
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: 129 N Washington St, Sumter, SC 29150
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Private
  • Hospital Type: Acute Care Hospitals