Occupational therapy (therapeutic activities)
Facility: Valley Children's Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $130
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.71x 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 371% of the Medicare baseline (a markup of 271%). 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 |
|---|---|---|
| Allcare Ipa | $13 - $118 | 37% |
| Community Care Ipa | $13 - $20 | 37% |
| Kaiser | $13 - $153 | 37% |
| Dignity Ipa_Formerly Img | $18 | 51% |
| La Salle Ipa | $18 | 51% |
| Sante Ipa | $18 | 51% |
| Central Valley Medical Providers Ipa | $19 - $118 | 54% |
| Sequoia Health Ipa | $19 | 54% |
| Univseral Healthcare Ipa | $19 | 54% |
| United Physicians Network Ipa | $20 - $118 | 57% |
| Adventist | $23 | 66% |
| Blue Cross Blue Shield | $23 - $719 | 66% |
| Cencal Health | $25 | 71% |
| Central California Alliance For Health | $26 | 74% |
| Kern Family Health Care | $26 | 74% |
| Health Net | $83 - $155 | 237% |
| Dignity Health Central Coast | $117 | 334% |
| Community Health | $130 | 371% |
| Stanislaus Partners In Health | $130 | 371% |
| Physicians Choice Medical Group | $132 | 376% |
| Health Plan Of San Joaquin | $142 | 405% |
| Fowler Packing | $146 | 416% |
| Dignity (Formerly Managed Care Systems) | $149 | 425% |
| Kern Legacy | $153 | 436% |
| Aetna | $158 | 451% |
| Blue Shield | $158 - $179 | 451% |
| UnitedHealthcare | $158 - $168 | 451% |
| First Health Formerly Coventry | $175 | 499% |
| Bakersfield Family Medical Group | $177 | 505% |
| Network By Design | $183 | 522% |
| Community Care Health Plan | $189 | 539% |
| Health Smart | $189 | 539% |
| Key Medical Ipa | $189 | 539% |
| Sutter Health | $201 | 573% |
| Multiplan | $226 | 644% |