CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Tomah Memorial Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,242
Cash Discount Price: $1,642
vs. Medicare Baseline: 5.09x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Tomah Memorial Hospital is $1,242. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,642. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 5.09x the Medicare baseline. Located in 501 Gopher Dr, Tomah, WI.

Cash / Self-Pay

$1,642

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,242

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: $1,642 (674%)

Insurance Median: $1,242 (509%)

Cash: $1,642 (674% of Medicare)

Ins. Median: $1,242 (509% 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 509% of the Medicare baseline (a markup of 409%). 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
UnitedHealthcare	$42 - $4,008	17%
Blue Cross Blue Shield	$60 - $3,910	25%
Group Hlth Mcr Adv - All Plans	$60 - $1,445	25%
Independent Care Mcr - All Other Plans	$60 - $1,445	25%
Quartz Mcr Adv	$60 - $1,445	25%
Security Hp Mcr Adv	$60 - $1,445	25%
Va Ccn - All Plans	$60 - $1,445	25%
Aetna	$70 - $3,612	29%
The Alliance - All Plans	$308 - $25,288	126%
Independent Care Mcaid	$385 - $404	158%
Managed Hlth Mcaid - All Plans	$385 - $404	158%
Quartz Mcaid	$385 - $404	158%
Security Hp Mcaid	$385 - $404	158%
Security Hp Comm - All Other Plans	$1,242 - $3,612	509%
Quartz Comm - All Other Plans	$1,316 - $3,825	540%
Humana	$1,352 - $3,931	555%
Cigna	$1,418 - $4,122	582%

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 $1,642.
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 Tomah Memorial 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.