Occupational therapy (therapeutic activities)
Facility: Adventist Health Hanford
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $120
- Cash Discount Price: $43
- vs. Medicare Baseline: 3.42x 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 342% of the Medicare baseline (a markup of 242%). 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 |
|---|---|---|
| Kaiser Mcal | $16 | 46% |
| Medi-Cal | $16 | 46% |
| Bc Mcal | $21 | 60% |
| Healthnet Mcal | $21 | 60% |
| Fresno - All Plans | $26 | 74% |
| Valley Childrens - All Plans | $27 | 77% |
| Blue Shield Mcr Adv | $37 | 106% |
| Fhcn Pace Mcr Adv-All Plans | $37 | 106% |
| Healthnet Mcr Adv | $37 | 106% |
| Kaiser Mcr Adv | $37 | 106% |
| Prime Health Mcr Adv- All Plans | $37 | 106% |
| Tricare | $37 | 106% |
| UnitedHealthcare | $37 - $292 | 106% |
| Bright Health Mcr Adv-All Plans | $58 | 165% |
| Ah Employee Health Plan - All Plans | $67 | 191% |
| Key Medical Group Commercial - All Other Plans | $75 | 214% |
| Key Medical Mcr Adv | $75 | 214% |
| Aetna | $81 - $402 | 231% |
| Western Growers/Pinnacle- All Plans | $105 | 299% |
| Kaiser - All Other Plans | $112 | 319% |
| Healthnet - All Other Plans | $120 | 342% |
| Cigna | $133 | 379% |
| Phcs Ppo- All Plans | $146 | 416% |
| Community Hlth Ntwork-All Plans | $150 | 428% |
| Interplan- All Plans | $150 | 428% |
| First Health - All Plans | $175 | 499% |
| Choicecare- All Plans | $184 | 525% |
| Multiplan- All Plans | $186 | 530% |
| Beech Street- All Plans | $190 | 542% |
| Preferred Health Network- All Plans | $213 | 607% |
| Pacific Health Alliance- All Plans | $217 | 619% |
| Blue Shield Epn | $347 | 989% |
| Blue Cross Blue Shield | $365 - $492 | 1041% |
| Blue Shield Non-Epn - All Other Plans | $409 | 1166% |