CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: UPMC Williamsport

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $118
Cash Discount Price: $130
vs. Medicare Baseline: 3.36x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at UPMC Williamsport is $118. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $130. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.36x the Medicare baseline. Located in 700 High Street, Williamsport, PA.

Cash / Self-Pay

$130

Average discount available for prompt cash payment at this facility.

Insurance Median

$118

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: $130 (371%)

Insurance Median: $118 (336%)

Cash: $130 (371% of Medicare)

Ins. Median: $118 (336% 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 336% of the Medicare baseline (a markup of 236%). 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%
Upmc Health Plan	$14 - $95	40%
Amerihealth Caritas	$15	43%
UnitedHealthcare	$17 - $148	48%
Highmark Wholecare (Prev Gateway)	$18	51%
Pa Health & Wellness	$22	63%
Upmc Work Partners	$54	154%
Aetna	$59 - $143	168%
Three Rivers Provider Network	$66 - $195	188%
Multiplan	$68 - $169	194%
Blue Cross Blue Shield	$86 - $102	245%
Coventry/First Health	$109 - $146	311%
Wirerope Works	$121	345%
Cigna	$149	425%
America'S Choice	$174	496%
Intergroup	$174	496%

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 $130.
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 Williamsport 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.