CMS Price Transparency Data

MRI, knee or other leg joint

Facility: Vandalia Health Broaddus Hospital

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,598
Cash Discount Price: $1,527
vs. Medicare Baseline: 6.56x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at Vandalia Health Broaddus Hospital is $1,598. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,527. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 6.56x the Medicare baseline. Located in 1 Healthcare Drive Mansfield Hill, Philippi, WV.

Cash / Self-Pay

$1,527

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,598

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: $1,527 (626%)

Insurance Median: $1,598 (656%)

Cash: $1,527 (626% of Medicare)

Ins. Median: $1,598 (656% 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 656% of the Medicare baseline (a markup of 556%). 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
Correctional Medical Systems	$46 - $138	19%
Aetna	$48 - $1,950	20%
The Health Plan	$48 - $1,963	20%
Unicare	$48 - $145	20%
Blue Cross Blue Shield	$117 - $1,547	48%
Peak Health	$376 - $695	154%
Highmark	$1,598	656%
UnitedHealthcare	$1,614 - $2,118	662%
Humana	$1,678	688%
West Virginia Senior Advantage	$1,695	695%
Cigna	$1,908	783%
First Health	$1,950	800%
Geisenger Health Plan	$2,028	832%
Health Network America	$2,028 - $2,072	832%
Multiplan/Phcs	$2,050	841%
Geha	$2,072	850%
Selectnet	$2,137	877%

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 $1,527.
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 Vandalia Health Broaddus 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.