CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: UPMC Carlisle

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $110
Cash Discount Price: $133
vs. Medicare Baseline: 3.40x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at UPMC Carlisle is $110. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $133. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.40x the Medicare baseline. Located in 361 Alexander Spring Road, Carlisle, PA.

Cash / Self-Pay

$133

Average discount available for prompt cash payment at this facility.

Insurance Median

$110

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $133 (410%)

Insurance Median: $110 (340%)

Cash: $133 (410% of Medicare)

Ins. Median: $110 (340% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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 340% of the Medicare baseline (a markup of 240%). 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
Prime Net	$22 - $212	68%
Aetna	$27 - $137	83%
UnitedHealthcare	$27 - $193	83%
Blue Cross Blue Shield	$32 - $154	99%
Keystone Health Plan	$32 - $154	99%
Upmc Work Partners	$44	136%
Upmc Health Plan	$85 - $197	262%
Geisinger	$89 - $203	275%
Pa Health & Wellness	$89 - $155	275%
Wellspan Population Health	$105 - $225	324%
Multiplan	$138 - $239	426%
Cigna	$387	1194%

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 $133.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm UPMC Carlisle is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.