Occupational therapy (therapeutic activities)
Facility: Adventist Health Lodi Memorial
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $97
- Cash Discount Price: $26
- vs. Medicare Baseline: 2.77x 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 277% of the Medicare baseline (a markup of 177%). 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% |
| Celtic Ins Company - All Plans | $18 | 51% |
| Hp Of San Joaquin Mcal | $20 | 57% |
| Bc Mcal | $22 | 63% |
| Healthnet Mcal | $23 | 66% |
| Alignment Health Plan (Ahp)-All Plans | $37 | 106% |
| Blue Shield Mcare Adv | $37 | 106% |
| Cca Health Plan Mcr Adv- All Plans | $37 | 106% |
| Healthnet Mcare | $37 | 106% |
| Hp Of San Joaquin Mcr Adv | $37 | 106% |
| Humana | $37 | 106% |
| Kaiser Mcr Adv | $37 | 106% |
| Tricare | $37 | 106% |
| UnitedHealthcare | $37 - $203 | 106% |
| Knnex Health - All Plans | $45 | 128% |
| Ah Employee Health Plan - All Plans | $67 | 191% |
| Bright Health - All Plans | $74 | 211% |
| Medcore(Omni Ipa) Op Only- All Plans | $97 | 277% |
| Aetna | $107 | 305% |
| Blue Shield Epn - All Other Plans | $121 | 345% |
| Blue Shield Non-Epn | $125 | 356% |
| Kaiser Commercial - All Other Plans | $153 | 436% |
| Healthnet- All Other Plans | $183 | 522% |
| Networks By Design- All Plans | $186 | 530% |
| Multiplan- All Plans | $298 | 850% |
| First Health- All Plans | $306 | 873% |
| Beech Street- All Plans | $336 | 958% |
| Cigna | $336 | 958% |
| Three Rivers Provider Network- All Plans | $336 | 958% |
| Hp Of San Joaquin Ppo - All Other Plans | $354 | 1009% |
| Western Growers- All Plans | $435 | 1240% |
| Blue Cross Blue Shield | $445 - $499 | 1269% |