MRI, knee or other leg joint
Facility: Regional Medical Center
Billing Code: 73721 (CPT)
- CPT Billing Code: 73721
- Insurance Median: $870
- Cash Discount Price: $2,842
- vs. Medicare Baseline: 3.57x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 357% of the Medicare baseline (a markup of 257%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medical Associates Health Plan - Tri | $870 | 357% |
Consumer Guidance & Cost Commentary
If you are a patient paying out-of-pocket for this MRI procedure, you should know that the cash price of $2,842 is often the most transparent starting point, though you must explicitly request a "self-pay" or "prompt-pay" discount before scheduling to avoid automatic insurance billing. Hospitals frequently offer immediate fee reductions of 20% to 50% for upfront payments to bypass costly claims processing and secure immediate liquidity, but these rates are only secured if you sign a waiver preventing the hospital from submitting a claim to your insurance. Since this facility is a government-owned Critical Access Hospital in Manchester, Iowa, and the only payer on record is Medical Associates Health Plan - Tri with a single rate of $870, it is crucial to verify whether your specific plan's negotiated rate exceeds the cash price; in some cases with high-deductible plans, paying the cash rate directly can result in lower total costs than the insurance negotiated amount.
The broader financial context for this service shows a gross charge of $3,552, which is significantly higher than the facility's cash rate, and the Medicare benchmark amount of $243.77 serves as the federal baseline for cost evaluation. While the facility holds a strong 4-star rating, the commercial negotiated rate of $870 is substantially higher than the cash price, reflecting the administrative overhead and contract dynamics inherent in insurance billing. Although specific county or state average data was not provided in the source information, the disparity between the gross charge and the cash price highlights the importance of understanding that commercial rates often include multi-layered administrative costs, whereas the cash rate represents a direct fee without insurance claim processing.