Occupational therapy (therapeutic activities)
Facility: Portneuf Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $141
- Cash Discount Price: $103
- vs. Medicare Baseline: 4.02x 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 402% of the Medicare baseline (a markup of 302%). 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 |
|---|---|---|
| Medicaid / KanCare | $29 | 83% |
| Bannock County Jail [6050] | $29 | 83% |
| Department of Corrections [1340] | $29 | 83% |
| Pending County Rca [3910] | $29 | 83% |
| UnitedHealthcare | $29 - $154 | 83% |
| Healthscope Benefits [2290] | $35 | 100% |
| Aetna | $35 - $145 | 100% |
| Employee Benefit Management Services [2445] | $70 - $103 | 200% |
| Lucent Health [6000] | $70 | 200% |
| Black Lung [6055] | $70 | 200% |
| Web Tpa [2115] | $70 | 200% |
| Moda Health [6100] | $70 | 200% |
| Healthcare Highways [2210] | $70 - $162 | 200% |
| Oncology Patient Assistance Programs [2295] | $70 | 200% |
| Pending Ssi [1616] | $70 | 200% |
| Pacific Source Health Plans [2850] | $98 | 279% |
| Medishare Christian Care [1645] | $103 | 294% |
| Liberty Health Share Lhs/Medcost Solutions LLC [2400] | $103 | 294% |
| Multiplan [1680] | $115 - $162 | 328% |
| Worker's Comp [2125] | $124 - $128 | 354% |
| Enablecomp [1350] | $128 | 365% |
| Transamerican Life [1990] | $128 | 365% |
| First Health [1375] | $141 | 402% |
| Mailhandlers [1595] | $145 | 413% |
| Selecthealth [3740] | $145 - $154 | 413% |
| Cigna | $151 | 431% |
| Humana | $154 | 439% |
| Geha [1415] | $154 | 439% |
| PHCS [1780] | $162 | 462% |
| Pan American Life Insurance Co [1770] | $162 | 462% |
| Administrative Concepts [1005] | $162 | 462% |
| Healthfirst [2395] | $162 | 462% |
| Healthnet [1495] | $162 | 462% |
| UT Id Teamsters [3760] | $162 | 462% |
| Meritain Health [1655] | $162 | 462% |
| Trustmark [2030] | $162 | 462% |
| Planned Administrators Inc [2360] | $162 | 462% |
| Mutual of Omaha [1685] | $162 | 462% |
| Hometown Health [2155] | $162 | 462% |
| Pba [1775] | $162 | 462% |
| Mayo Clinic Health Solutions [2280] | $162 | 462% |
| National Association of Letter Carriers [1695] | $162 | 462% |
| New Era Life Insurance Company [1705] | $162 | 462% |