CMS Price Transparency Data

MRI, knee or other leg joint

Facility: UPMC Kane

Billing Code: 73721 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 73721
Insurance Median: $1,466
Cash Discount Price: $2,182
vs. Medicare Baseline: 6.01x Medicare

The contracted insurance negotiated median rate for a MRI, knee or other leg joint at UPMC Kane is $1,466. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,182. Compared to the federal Medicare reimbursement reference rate of $243.77, this hospital’s rate is 6.01x the Medicare baseline. Located in 4372 Route 6, Kane, PA.

Cash / Self-Pay

$2,182

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,466

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: $2,182 (895%)

Insurance Median: $1,466 (601%)

Cash: $2,182 (895% of Medicare)

Ins. Median: $1,466 (601% 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 601% of the Medicare baseline (a markup of 501%). 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	$85 - $3,175	35%
Blue Cross Blue Shield	$90 - $2,691	37%
Highmark Wholecare (Prev Gateway)	$92 - $2,767	38%
Aetna	$93 - $2,798	38%
UnitedHealthcare	$94 - $2,960	39%
Amerihealth Caritas	$97 - $2,906	40%
Geisinger	$133 - $4,000	55%
PA Health & Wellness	$133 - $4,000	55%
Horizon Health Plan	$169 - $5,090	69%
Cigna	$169 - $163,707	69%
Multiplan	$182 - $5,454	75%
Health Coalition Partners	$194 - $5,818	80%
Intergroup	$194 - $5,818	80%
Focus Healthcare	$230 - $6,908	94%
UPMC Work Partners	$1,083	444%

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 $2,182.
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 Kane 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.