CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: UPMC Presbyterian Shadyside

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $281
Cash Discount Price: $259
vs. Medicare Baseline: 8.01x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at UPMC Presbyterian Shadyside is $281. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $259. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 8.01x the Medicare baseline. Located in 200 Lothrop Street, Pittsburgh, PA.

Cash / Self-Pay

$259

Average discount available for prompt cash payment at this facility.

Insurance Median

$281

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: $259 (739%)

Insurance Median: $281 (801%)

Cash: $259 (739% of Medicare)

Ins. Median: $281 (801% 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 801% of the Medicare baseline (a markup of 701%). 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
Upmc Health Plan	$14 - $116	40%
UnitedHealthcare	$16	46%
Aetna	$17 - $108	48%
Highmark Wholecare (Prev Gateway)	$19 - $216	54%
Geisinger	$20	57%
Health Partners Plans (Jefferson Health Plan)	$20	57%
Amerihealth Caritas	$21	60%
Blue Cross Blue Shield	$21 - $92	60%
Pa Health & Wellness	$22	63%
Upmc Work Partners	$63	180%
Multiplan	$74 - $346	211%
Preferred Healthcare System	$281	801%
Coventry/First Health	$302	861%
Fidelis	$324	924%
Intergroup	$324 - $367	924%
Health Coalition Partners	$346	987%
Private Health Care Systems	$346	987%
Selectcare	$346	987%
Health Payors Organization	$367	1046%
Humana	$367	1046%

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 $259.
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 Presbyterian Shadyside 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.