Occupational therapy (therapeutic activities)
Facility: John Muir Medical Center - Walnut Creek Campus
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $175
- Cash Discount Price: $160
- vs. Medicare Baseline: 4.99x 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 499% of the Medicare baseline (a markup of 399%). 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 |
|---|---|---|
| Jmpn Canopy Hn [1640000011] | $8 - $44 | 23% |
| UnitedHealthcare | $8 - $213 | 23% |
| Contra Costa County Jail [1012104] | $11 | 31% |
| Golden State-Network Mcare [1023127] | $37 - $44 | 106% |
| Tricare | $37 - $49 | 106% |
| Health Net-Network Mcare [1028127] | $40 - $43 | 114% |
| Aetna | $41 - $270 | 117% |
| Alignment Health [1177113] | $41 - $44 | 117% |
| Blue Cross Blue Shield | $41 - $589 | 117% |
| Blue Shield-Network Mcare [1006127] | $41 - $49 | 117% |
| Care 1St Health Plan [1094113] | $41 - $44 | 117% |
| Caremore [1171113] | $41 - $44 | 117% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund [1179012] | $41 - $49 | 117% |
| Easy Choice Health Plan [1083113] | $41 - $49 | 117% |
| Essence Healthcare [1049028] | $41 - $44 | 117% |
| Essence Healthcare [1049128] | $41 - $44 | 117% |
| Humana | $41 - $302 | 117% |
| Medicare (plans) | $41 - $291 | 117% |
| Scan-Network Mcare [1043127] | $41 - $49 | 117% |
| Veterans Administration [1051113] | $41 - $44 | 117% |
| Generic Commercial/Indemnity [1017001] | $44 - $146 | 125% |
| Generic Hmo [1018103] | $44 | 125% |
| Generic Ppo [1021104] | $44 | 125% |
| Hospice Of East Bay [1085104] | $49 | 140% |
| Workers' Comp [1024005] | $59 | 168% |
| Canopy Hn Hmo [1166103] | $75 - $81 | 214% |
| Carecentrix [1011001] | $139 - $146 | 396% |
| Aps Healthcare [1003103] | $157 - $164 | 448% |
| United Behavioral Health [1048103] | $175 - $183 | 499% |
| Cigna | $177 - $261 | 505% |
| Carelon Behavioral Health [1050104] | $192 - $200 | 547% |
| Fortified Provider Network [1063104] | $192 - $200 | 547% |
| Medigap [1036001] | $192 - $200 | 547% |
| Three Rivers Provider Network [1073104] | $192 - $200 | 547% |
| Health Net Hmo [1028103] | $199 - $208 | 567% |
| Health Net-Network [1028026] | $199 - $208 | 567% |
| Contra Costa Health Plan Hmo [1013103] | $209 - $219 | 596% |
| Blue Shield Hmo [1006103] | $216 - $231 | 616% |
| Blue Shield-Network [1006026] | $216 - $231 | 616% |
| Blue Shield Ppo [1006104] | $232 - $268 | 662% |
| Western Health Advantage Hmo [1053103] | $244 - $291 | 696% |
| Health Net Ppo [1028104] | $253 - $265 | 721% |
| Federal Correction Institute [1062104] | $279 - $291 | 796% |
| First Health [1016104] | $279 - $310 | 796% |
| Healthsmart - Pka Interplan [1031104] | $279 - $291 | 796% |
| National Provider Network/Plancare America [1069104] | $279 - $291 | 796% |
| Networks By Design [1084104] | $279 - $291 | 796% |
| Pponext [1072104] | $279 - $291 | 796% |
| Sutter Preferred Health Plan [1044104] | $279 - $291 | 796% |
| Kaiser Hmo [1033103] | $282 - $295 | 804% |
| Health Management Network [1066104] | $296 - $310 | 844% |
| Healthcomp [1089104] | $296 - $589 | 844% |
| Galaxy Health Network [1064104] | $313 - $328 | 893% |
| Integrated Health Plan [1075104] | $313 - $328 | 893% |
| Brms [1091104] | $504 - $589 | 1437% |
| Delta Health Systems [1032104] | $504 - $589 | 1437% |
| Empire Plan [1092104] | $504 - $589 | 1437% |
| Donor Network West [1008103] | $8,000 - $12,000 | 22812% |