CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Banner - University Medical Center Tucson Campus

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $76
Cash Discount Price: $29
vs. Medicare Baseline: 2.17x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Banner - University Medical Center Tucson Campus is $76. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $29. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.17x the Medicare baseline. Located in 1625 North Campbell Avenue, Tucson, AZ.

Cash / Self-Pay

$29

Average discount available for prompt cash payment at this facility.

Insurance Median

$76

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: $29 (83%)

Insurance Median: $76 (217%)

Cash: $29 (83% of Medicare)

Ins. Median: $76 (217% 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 217% of the Medicare baseline (a markup of 117%). 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	$30 - $81	86%
Arizona Physicians Ipa	$36	103%
Health Net	$36 - $80	103%
Mercy Care	$36	103%
Health Choice Arizona, Inc.	$44 - $74	125%
University Of Arizona (Kasser Medical Treatment Center)	$52	148%
Arizona Priority Care	$59	168%
National Healthcare Solutions Inc (Nhsi) And Vip Universal Medical Insurance Group (Vumi)	$67	191%
Plotkin Health	$67	191%
Oscar Health Plan	$74	211%
Quiktrip Corporation	$80	228%
Blue Cross Blue Shield	$107 - $142	305%
Provider Network Of America	$111	317%
Arizona Medical Network	$118	336%
Cigna	$225	642%
UnitedHealthcare	$268	764%

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 $29.
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 Banner - University Medical Center Tucson Campus 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.