CMS Price Transparency Data

MRI, lower back (no contrast)

Facility: UPMC St Margaret

Billing Code: 72148 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72148
Insurance Median: $1,743
Cash Discount Price: $3,683
vs. Medicare Baseline: 7.15x Medicare

The contracted insurance negotiated median rate for a MRI, lower back (no contrast) at UPMC St Margaret is $1,743. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,683. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 7.15x the Medicare baseline. Located in 815 Freeport Road, Pittsburgh, PA.

Cash / Self-Pay

$3,683

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,743

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: $3,683 (1511%)

Insurance Median: $1,743 (715%)

Cash: $3,683 (1511% of Medicare)

Ins. Median: $1,743 (715% 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 715% of the Medicare baseline (a markup of 615%). 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
Upmc Health Plan	$199 - $542	82%
Aetna	$242 - $2,455	99%
Highmark Wholecare (Prev Gateway)	$249 - $3,069	102%
Pa Health & Wellness	$249 - $437	102%
UnitedHealthcare	$282	116%
Amerihealth Caritas	$400	164%
Blue Cross Blue Shield	$625 - $3,730	256%
Premier Comp Solutions	$1,252	514%
Upmc Work Partners	$1,345	552%
Cigna	$1,719 - $2,455	705%
Coventry/First Health	$4,297	1763%
Private Health Care Systems	$4,910	2014%
Selectcare	$4,910	2014%
Humana	$5,217	2140%

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 $3,683.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72148.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC St Margaret is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72148.
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.