CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Saint Vincent Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $33
Cash Discount Price: $212
vs. Medicare Baseline: 0.94x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Saint Vincent Hospital is $33. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $212. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 0.94x the Medicare baseline. Located in 232 West 25Th Street, Erie, PA.

Cash / Self-Pay

$212

Average discount available for prompt cash payment at this facility.

Insurance Median

$33

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: $212 (605%)

Insurance Median: $33 (94%)

Cash: $212 (605% of Medicare)

Ins. Median: $33 (94% 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.

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	$10 - $90	29%
Amerihealth	$14 - $35	40%
Highmark	$16 - $52	46%
Pennsylvania Health And Wellness	$17	48%
Geisinger	$19	54%
Univera	$30 - $40	86%
American Health Plans	$33	94%
Life Pittsburgh	$33	94%
Martin'S Point	$33	94%
University Of Pittsburgh Medical Center	$33 - $48	94%
Aetna	$34 - $67	97%
Medicare (plans)	$34	97%
Blue Cross Blue Shield	$35 - $52	100%
Cigna	$35 - $58	100%
Highmark Wholecare	$35	100%
Humana	$35	100%
Molina	$36	103%

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 $212.
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 Saint Vincent Hospital 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.