CMS Price Transparency Data

MRI, knee or other leg joint

Facility: UPMC Presbyterian Shadyside

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $6,732
Cash Discount Price: $6,214
vs. Medicare Baseline: 27.62x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at UPMC Presbyterian Shadyside is $6,732. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $6,214. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 27.62x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$6,214

Average discount available for prompt cash payment at this facility.

Insurance Median

$6,732

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: $6,214 (2549%)

Insurance Median: $6,732 (2762%)

Cash: $6,214 (2549% of Medicare)

Ins. Median: $6,732 (2762% 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 2762% of the Medicare baseline (a markup of 2662%). 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
Amerihealth Caritas	$249	102%
Cigna	$249	102%
Highmark Wholecare (Prev Gateway)	$249 - $5,178	102%
Pa Health & Wellness	$249	102%
UnitedHealthcare	$249 - $323	102%
Aetna	$254 - $2,589	104%
Blue Cross Blue Shield	$539 - $3,579	221%
Premier Comp Solutions	$1,097	450%
Upmc Work Partners	$1,180	484%
Multiplan	$1,372 - $8,286	563%
Upmc Health Plan	$4,856	1992%
Geisinger	$5,696	2337%
Preferred Healthcare System	$6,732	2762%
Coventry/First Health	$7,250	2974%
Fidelis	$7,768	3187%
Intergroup	$7,768 - $8,803	3187%
Health Coalition Partners	$8,286	3399%
Private Health Care Systems	$8,286	3399%
Selectcare	$8,286	3399%
Health Payors Organization	$8,803	3611%
Humana	$8,803	3611%

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 $6,214.
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 Presbyterian Shadyside 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.