CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Porter Hospital Inc

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $290
Cash Discount Price: $1,904
vs. Medicare Baseline: 1.19x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Porter Hospital Inc is $290. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,904. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 1.19x the Medicare baseline. Located in 115 Porter Drive, Middlebury, VT.

Cash / Self-Pay

$1,904

Average discount available for prompt cash payment at this facility.

Insurance Median

$290

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: $1,904 (781%)

Insurance Median: $290 (119%)

Cash: $1,904 (781% of Medicare)

Ins. Median: $290 (119% 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.

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
UnitedHealthcare	$42 - $3,435	17%
Fidelis Care	$55 - $1,468	23%
Humana	$58 - $230	24%
Capital District Physicians' Health Plan	$60 - $2,894	25%
Aetna	$61 - $1,631	25%
Martins Point	$61 - $1,631	25%
Veterans Affairs Community Care Network	$61 - $1,631	25%
Veterans Choice	$61 - $1,631	25%
Blue Cross Blue Shield	$70 - $3,270	29%
Harvard Pilgrim	$71 - $2,776	29%
Coventry	$79 - $3,054	32%
Cigna	$88 - $3,156	36%
Mvp	$90 - $3,234	37%
Wellpath	$185 - $1,908	76%
Medical Corporation	$320 - $3,296	131%
Multiplan	$320 - $3,296	131%

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 $1,904.
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 Porter Hospital Inc 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.