CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: UPMC Muncy

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $80
Cash Discount Price: $96
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at UPMC Muncy is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.28x the Medicare baseline. Located in 215 East Water Street, Muncy, PA.

Cash / Self-Pay

$96

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $96 (274%)

Insurance Median: $80 (228%)

Cash: $96 (274% of Medicare)

Ins. Median: $80 (228% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 228% of the Medicare baseline (a markup of 128%). 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
Geisinger	$14 - $145	40%
Highmark Wholecare (Prev Gateway)	$14 - $33	40%
Upmc Health Plan	$14 - $95	40%
Amerihealth Caritas	$15 - $2,208	43%
Cigna	$16 - $149	46%
Pa Health & Wellness	$17 - $2,316	48%
UnitedHealthcare	$17 - $148	48%
Blue Cross Blue Shield	$40 - $100	114%
Aetna	$42 - $143	120%
Coventry/First Health	$52 - $146	148%
Upmc Work Partners	$54 - $62	154%
Wirerope Works	$57 - $121	163%
Three Rivers Provider Network	$66 - $195	188%
Multiplan	$80 - $206	228%
America'S Choice	$82 - $174	234%
Intergroup	$82 - $174	234%

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 $96.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

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 97530.
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.