CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Sanford Clear Lake Medical Center

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $3,131
Cash Discount Price: $3,054
vs. Medicare Baseline: 12.84x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Sanford Clear Lake Medical Center is $3,131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,054. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 12.84x the Medicare baseline. Located in 701 Third Avenue South, Clear Lake, SD.

Cash / Self-Pay

$3,054

Average discount available for prompt cash payment at this facility.

Insurance Median

$3,131

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: $3,054 (1253%)

Insurance Median: $3,131 (1284%)

Cash: $3,054 (1253% of Medicare)

Ins. Median: $3,131 (1284% 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 1284% of the Medicare baseline (a markup of 1184%). 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
Blue Cross Blue Shield	$1,156	474%
Sanford Health Plan Align	$1,958	803%
Security Health Plan	$2,099	861%
Ucare	$2,103 - $3,354	863%
Wellmark Sd	$2,103	863%
Aetna	$2,122 - $3,317	870%
Health Partners	$2,122 - $2,863	870%
Medicare (plans)	$2,122	870%
UnitedHealthcare	$2,122 - $3,187	870%
Primewest	$2,164	888%
Sanford Health Plan	$2,646 - $3,549	1085%
Medica	$3,149 - $3,367	1292%
Wellmark	$3,283 - $3,321	1347%
Cigna	$3,435	1409%
First Choice Health Network	$3,435	1409%
Healthez	$3,435	1409%
Multiplan	$3,435	1409%

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 $3,054.
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 Sanford Clear Lake 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.