CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Sycamore Shoals Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $495
Cash Discount Price: $610
vs. Medicare Baseline: 2.03x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Sycamore Shoals Hospital is $495. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $610. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 2.03x the Medicare baseline. Located in 1501 West Elk Avenue, Elizabethton, TN.

Cash / Self-Pay

$610

Average discount available for prompt cash payment at this facility.

Insurance Median

$495

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: $610 (250%)

Insurance Median: $495 (203%)

Cash: $610 (250% of Medicare)

Ins. Median: $495 (203% 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 203% of the Medicare baseline (a markup of 103%). 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
Amerigroup	$215 - $514	88%
Aetna	$216 - $2,615	89%
Humana	$216 - $478	89%
Managed Medicaire	$216 - $478	89%
Medicare (plans)	$216 - $478	89%
Sentara Health	$216 - $1,140	89%
United Mine Workers Of America	$216 - $478	89%
UnitedHealthcare	$216 - $4,099	89%
Blue Cross Blue Shield	$223 - $1,009	91%
Molina Healthcare	$225 - $515	92%
Cigna	$227 - $1,025	93%
Devoted Health Plan	$227 - $502	93%
Nhc Advantage	$227 - $502	93%
Wellcare	$229 - $4,099	94%
Optima Health	$330 - $495	135%
Ambetter / Centene	$472 - $1,041	194%
Medcost	$1,412 - $1,435	579%
First Health Coventry	$3,025 - $3,074	1241%
Seven Corners, Inc.	$4,033 - $4,099	1654%

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 $610.
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 Sycamore Shoals 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.