CMS Price Transparency Data

MRI, knee or other leg joint

Facility: UPMC Somerset

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,190
Cash Discount Price: $1,656
vs. Medicare Baseline: 4.88x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at UPMC Somerset is $1,190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,656. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 4.88x the Medicare baseline. Located in 225 South Center Avenue, Somerset, PA.

Cash / Self-Pay

$1,656

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,190

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: $1,656 (679%)

Insurance Median: $1,190 (488%)

Cash: $1,656 (679% of Medicare)

Ins. Median: $1,190 (488% 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 488% of the Medicare baseline (a markup of 388%). 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	$309 - $1,190	127%
Upmc Health Plan	$365 - $1,680	150%
Amerihealth Caritas	$380	156%
Highmark Wholecare (Prev Gateway)	$425 - $1,380	174%
Geisinger	$461 - $1,087	189%
Blue Cross Blue Shield	$529	217%
Upmc Work Partners	$1,083	444%
Aetna	$1,104	453%
Multiplan	$1,380 - $1,794	566%
Galaxy Health Plan	$1,794	736%
Humana	$2,070	849%

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 $1,656.
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 UPMC Somerset 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.