CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: UPMC Somerset

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $54
Cash Discount Price: $65
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at UPMC Somerset is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.54x the Medicare baseline. Located in 225 South Center Avenue, Somerset, PA.

Cash / Self-Pay

$65

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

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: $65 (185%)

Insurance Median: $54 (154%)

Cash: $65 (185% of Medicare)

Ins. Median: $54 (154% 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
Upmc Health Plan	$14 - $72	40%
Amerihealth Caritas	$15	43%
UnitedHealthcare	$15 - $58	43%
Highmark Wholecare (Prev Gateway)	$17 - $67	48%
Geisinger	$18 - $53	51%
Blue Cross Blue Shield	$20	57%
Aetna	$33 - $54	94%
Multiplan	$42 - $87	120%
Galaxy Health Plan	$54 - $87	154%
Upmc Work Partners	$60	171%
Humana	$62 - $100	177%
Premier Comp Solutions	$70	200%

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 $65.
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 Somerset 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.