CMS Price Transparency Data

MRI, knee or other leg joint

Facility: UPMC Passavant

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,806
Cash Discount Price: $3,802
vs. Medicare Baseline: 7.41x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at UPMC Passavant is $1,806. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $3,802. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 7.41x the Medicare baseline. Located in 9100 Babcock Boulevard, Pittsburgh, PA.

Cash / Self-Pay

$3,802

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,806

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: $3,802 (1560%)

Insurance Median: $1,806 (741%)

Cash: $3,802 (1560% of Medicare)

Ins. Median: $1,806 (741% 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 741% of the Medicare baseline (a markup of 641%). 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	$214 - $466	88%
Health Plan Of Upper Ohio Valley	$230 - $2,927	94%
Aetna	$242 - $254	99%
UnitedHealthcare	$242 - $254	99%
Amerihealth Caritas	$249	102%
Highmark Wholecare (Prev Gateway)	$249	102%
Pa Health & Wellness	$249 - $3,485	102%
Blue Cross Blue Shield	$539 - $3,215	221%
Premier Comp Solutions	$1,094	449%
Upmc Work Partners	$1,176	482%
Private Health Care Systems	$1,368 - $5,892	561%
Cigna	$2,154 - $2,534	884%
Coventry/First Health	$4,435	1819%
Intergroup	$5,259 - $5,702	2157%
Humana	$5,386 - $5,892	2209%
Multiplan	$5,386 - $5,892	2209%

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 $3,802.
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 Passavant 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.