CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: UPMC Children's Hospital of Pittsburgh

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $87
Cash Discount Price: $112
vs. Medicare Baseline: 2.48x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at UPMC Children's Hospital of Pittsburgh is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $112. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.48x the Medicare baseline. Located in One Children's Hospital Drive, Pittsburgh, PA.

Cash / Self-Pay

$112

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $112 (319%)

Insurance Median: $87 (248%)

Cash: $112 (319% of Medicare)

Ins. Median: $87 (248% 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 248% of the Medicare baseline (a markup of 148%). 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
Aetna	$28 - $102	80%
Upmc Health Plan	$30 - $89	86%
Amerihealth Caritas	$49	140%
Health Partners Plans (Jefferson Health Plan)	$50	143%
Highmark Wholecare (Prev Gateway)	$52	148%
UnitedHealthcare	$52 - $87	148%
Geisinger	$53 - $84	151%
Pa Health & Wellness	$53	151%
Blue Cross Blue Shield	$58 - $93	165%
Cigna	$87 - $102	248%
Health Plan Of Upper Ohio Valley	$121	345%
Intergroup	$121 - $158	345%
Coventry/First Health	$149	425%
Saudi Armed Forces	$149	425%
Health Payors Organization	$158	451%
Multiplan	$158	451%
National Provider Network	$167	476%
Private Health Care Systems	$167	476%

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 $112.
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 Children's Hospital of Pittsburgh 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.