CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Carilion Stonewall Jackson Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,980
Cash Discount Price: $1,349
vs. Medicare Baseline: 8.12x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Carilion Stonewall Jackson Hospital is $1,980. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,349. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 8.12x the Medicare baseline. Located in 1 Health Circle, Lexington, VA.

Cash / Self-Pay

$1,349

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,980

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: $1,349 (553%)

Insurance Median: $1,980 (812%)

Cash: $1,349 (553% of Medicare)

Ins. Median: $1,980 (812% 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 812% of the Medicare baseline (a markup of 712%). 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	$186 - $1,113	76%
Sentara Health Plan	$190 - $2,390	78%
UnitedHealthcare	$195 - $3,151	80%
Abh of Wva (Formerly Coventry)	$195	80%
Abh of VA (Formerly Coventry)	$195	80%
Humana	$195 - $227	80%
Aetna	$209 - $2,560	86%
Gateway - Tier 3	$2,120	870%
Vhn - Ultra	$2,390	980%
Connecticare	$2,698	1107%
Gateway - Tier 2	$3,084	1265%
Vhn - Plus	$3,084	1265%
Cigna	$3,088	1267%
Vhn	$3,277	1344%
Integrated Health Plan	$3,277	1344%
Vhn - Link	$3,470	1423%
Beech Street	$3,547	1455%
Gateway - Tier 1	$3,662	1502%
Vhn - Secondary Payors	$3,662	1502%

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 $1,349.
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 Carilion Stonewall Jackson 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.