Occupational therapy (therapeutic activities)
Facility: AHMC Seton Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $51
- Cash Discount Price: $182
- vs. Medicare Baseline: 1.45x 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.
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 |
|---|---|---|
| Medi-Cal | $9 | 26% |
| San Francisco Health Plan | $12 | 34% |
| Cmac | $13 | 37% |
| Hill Physicians Medical Group Inc | $13 - $54 | 37% |
| Kaiser | $13 - $187 | 37% |
| San Mateo County/San Mateo County General Hospital | $14 | 40% |
| Asian American Medical Group | $15 - $56 | 43% |
| Blue Cross Blue Shield | $16 - $173 | 46% |
| Brown And Toland Medical Group | $16 - $56 | 46% |
| Health Plan Of San Mateo Healthworx | $16 | 46% |
| North East Medical Services | $16 - $44 | 46% |
| Jade Health Care Mg | $17 - $47 | 48% |
| Health Plan Of San Mateo | $18 | 51% |
| Veterans Administration (Va) | $31 | 88% |
| Athens Administrators | $33 | 94% |
| Corvel Healthcare | $33 | 94% |
| Multiplan/Bce Emergis | $33 - $171 | 94% |
| Work Comp Other | $33 | 94% |
| Self Pay | $34 - $78 | 97% |
| Aetna | $44 - $153 | 125% |
| Apcmg | $44 - $67 | 125% |
| Blue Shield Of California | $44 - $214 | 125% |
| Brand New Day | $44 - $56 | 125% |
| Canopy Health | $44 - $80 | 125% |
| Care Advantage | $44 | 125% |
| Chinese Community Health Plan | $44 - $114 | 125% |
| Covid-19 Uninsured Program | $44 | 125% |
| For Your Benefit | $44 | 125% |
| Healthnet Seniority | $44 | 125% |
| Humana | $44 | 125% |
| Imperial Health Plan | $44 | 125% |
| Medicare (plans) | $44 | 125% |
| Pacificare | $44 | 125% |
| Tricare | $44 | 125% |
| UnitedHealthcare | $44 - $796 | 125% |
| Easy Choice Hospital Services | $45 | 128% |
| Central Health Plan | $47 | 134% |
| Ahmc Health | $56 | 160% |
| Knox-Keene Act | $56 | 160% |
| Interplan Corporation | $137 | 391% |
| Cigna | $160 | 456% |
| Healthcare Foundation Of San Mateo | $160 - $171 | 456% |
| Private Healthcare Sytems Inc | $171 | 488% |
| The First Health Network | $171 | 488% |
| Health Net | $175 | 499% |
| Beech Street Corporation | $182 | 519% |
| Choicecare Network | $194 | 553% |
| Multiplan | $194 | 553% |
| Mills Peninsula Health Services | $205 | 585% |
| Indemnity | $228 | 650% |
| Workers Compensation Federal | $228 | 650% |