Occupational therapy (therapeutic activities)
Facility: Johnson Memorial Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $146
- Cash Discount Price: $109
- vs. Medicare Baseline: 4.16x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 416% of the Medicare baseline (a markup of 316%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $36 - $154 | 103% |
| Blue Cross Blue Shield | $36 - $146 | 103% |
| Medicare (plans) | $36 - $38 | 103% |
| UnitedHealthcare | $36 - $369 | 103% |
| Cca Senior Care Options | $37 | 106% |
| Cigna | $38 - $181 | 108% |
| Fallon Health | $48 | 137% |
| Connecticut Dept of Correction | $66 | 188% |
| Claimdoc | $78 | 222% |
| Innovative Health Plan II | $78 | 222% |
| Diversified Administrators | $78 | 222% |
| Centivo | $87 | 248% |
| Health New England | $129 | 368% |
| Wellpoint | $146 | 416% |
| Blue Benefit Administrators of Massachusetts | $146 | 416% |
| Kaiser Domestic | $146 | 416% |
| Blue Shield - Ny Highmark Western | $146 | 416% |
| Blue Shield - Id (Regence) | $146 | 416% |
| Health Choices | $146 | 416% |
| Blue Shield - Ca | $146 | 416% |
| Blue Shield - PA (Highmark) | $146 | 416% |
| Blue Shield - Wa (Regence) | $146 | 416% |
| Blue Distinction Transplant | $146 | 416% |
| Pre-Employment | $146 | 416% |
| Blue Care Network | $146 | 416% |
| Bcn Domestic | $146 | 416% |
| Unicare | $146 | 416% |
| Wc Domestic | $146 | 416% |
| Blue Shield - Ny Highmark Northeastern | $146 | 416% |
| Gravie Admin Services | $154 | 439% |
| Allied Benefit Systems | $154 | 439% |
| Hap | $154 | 439% |
| Luminare Health | $154 | 439% |
| Nippon Life Ins | $154 | 439% |
| Webtpa | $154 | 439% |
| 1199 National Benefit Fund | $154 | 439% |
| Meritain | $154 | 439% |
| Prime Health Services | $158 | 451% |
| International Benefit Administrators | $164 | 468% |
| Trinity Health Share | $164 | 468% |
| Dean Health | $164 | 468% |
| Family Life Insurance Company | $164 | 468% |
| Medi Share | $164 | 468% |
| Paramount HMO | $164 | 468% |
| Allied National Global Care | $164 | 468% |
| Lifetime Benefit Solutions | $164 | 468% |
| Multiplan | $164 | 468% |
| Manhattan Life | $164 | 468% |
| Pan-American Life | $164 | 468% |
| Pai | $164 | 468% |
| Asrm - Reliance Standard Life Insurance | $164 | 468% |
| Ghc Scw | $164 | 468% |
| PHCS | $164 | 468% |
| Christian Care Ministry | $164 | 468% |
| Mvp | $164 | 468% |
| Health Smart | $168 | 479% |
| Allegiance | $181 | 516% |
| Magnacare | $181 | 516% |
| Health Partners | $181 | 516% |
| United Behavioral Health Eap | $198 | 565% |
| Connecticare | $242 - $314 | 690% |
| Harvard Pilgrim Healthcare | $369 | 1052% |
| Geha | $369 | 1052% |