CMS Price Transparency Data

CT scan, lower back (lumbar spine)

Facility: UPMC Muncy

Billing Code: 72131 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 72131
Insurance Median: $1,809
Cash Discount Price: $2,051
vs. Medicare Baseline: 16.94x Medicare

The contracted insurance negotiated median rate for a CT scan, lower back (lumbar spine) at UPMC Muncy is $1,809. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $2,051. Compared to the federal Medicare reimbursement reference rate of $106.81, this hospital’s rate is 16.94x the Medicare baseline. Located in 215 East Water Street, Muncy, PA.

Cash / Self-Pay

$2,051

Average discount available for prompt cash payment at this facility.

Insurance Median

$1,809

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$106.81

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $106.81 (100%)

Cash / Self-Pay: $2,051 (1920%)

Insurance Median: $1,809 (1694%)

Cash: $2,051 (1920% of Medicare)

Ins. Median: $1,809 (1694% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $106.81 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 1694% of the Medicare baseline (a markup of 1594%). 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	$113 - $2,339	106%
Geisinger	$152 - $2,291	142%
Upmc Health Plan	$152 - $1,491	142%
Highmark Wholecare (Prev Gateway)	$155 - $513	145%
Amerihealth Caritas	$156 - $2,208	146%
Pa Health & Wellness	$236 - $2,316	221%
Cigna	$538 - $2,342	504%
Upmc Work Partners	$701	656%
Three Rivers Provider Network	$750 - $3,077	702%
Blue Cross Blue Shield	$1,341 - $1,579	1256%
Aetna	$1,386 - $2,257	1298%
Coventry/First Health	$1,713 - $2,301	1604%
Wirerope Works	$1,901	1780%
Multiplan	$2,667 - $3,248	2497%
America'S Choice	$2,735	2561%
Intergroup	$2,735	2561%

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 $2,051.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 72131.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Muncy is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 72131.
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.