CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Penn State Health Lancaster Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $35
Cash Discount Price: $62
vs. Medicare Baseline: 1.00x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Penn State Health Lancaster Medical Center is $35. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.00x the Medicare baseline. Located in 2160 State Road, Lancaster, PA.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$35

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: $62 (177%)

Insurance Median: $35 (100%)

Cash: $62 (177% of Medicare)

Ins. Median: $35 (100% 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
[Amerihealth Caritas]	$29 - $34	83%
[Highmark Wholecare]	$29 - $34	83%
[Geisinger]	$30 - $143	86%
[Health Partners Plans]	$31 - $34	88%
[Pa Health & Wellness]	$31 - $35	88%
[Highmark]	$33 - $102	94%
Aetna	$34 - $263	97%
Humana	$34	97%
UnitedHealthcare	$34 - $134	97%
[Cbc]	$34 - $108	97%
[Healthspring]	$34	97%
[Upmc]	$34 - $158	97%
[Point Comfort Underwriters]	$42	120%
[Highmark Choice Blue]	$82	234%
[Highmark Aca]	$86	245%
Cigna	$131	374%
[First Health]	$171	488%
[Multiplan]	$171	488%

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 $62.
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 Penn State Health Lancaster Medical Center 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.