CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Stoughton Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,846
Cash Discount Price: $2,308
vs. Medicare Baseline: 7.57x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Stoughton Hospital is $1,846. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,308. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 7.57x the Medicare baseline. Located in 900 Ridge St, Stoughton, WI.

Cash / Self-Pay

$2,308

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,846

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: $2,308 (947%)

Insurance Median: $1,846 (757%)

Cash: $2,308 (947% of Medicare)

Ins. Median: $1,846 (757% 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 757% of the Medicare baseline (a markup of 657%). 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
Medicaid / KanCare	$290	119%
Tricare	$999	410%
Healthnet Mcr Adv - All Plans	$1,116	458%
Dean Health Insurance Med Adv	$1,175	482%
Humana	$1,175 - $3,776	482%
Quartz Mcr Adv	$1,175	482%
Security Health/First Health - All Plans	$1,175	482%
Dean Health Insurance Comm - All Other Plans	$1,249	512%
Dean Health Insurance Epo	$1,249	512%
Aetna	$1,259 - $3,567	516%
UnitedHealthcare	$1,846 - $3,357	757%
Geha - All Plans	$3,147	1291%
Cigna	$3,357	1377%
Wisconsin Ppo Ppa Direct - All Plans	$3,357	1377%
Quartz Health Solutions - All Other Lans	$3,446	1414%
Blue Cross Blue Shield	$3,651	1498%
Wps - All Plans	$3,776	1549%
Alliance - All Plans	$16,784	6885%

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 $2,308.
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 Stoughton 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.