Occupational therapy (therapeutic activities)
Facility: John Muir Behavioral Health Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $149
- Cash Discount Price: $153
- vs. Medicare Baseline: 4.25x 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 425% of the Medicare baseline (a markup of 325%). 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 |
|---|---|---|
| Alignment Health [1177113] | $44 | 125% |
| Blue Cross Blue Shield | $44 - $372 | 125% |
| Care 1St Health Plan [1094113] | $44 | 125% |
| Caremore [1171113] | $44 | 125% |
| Essence Healthcare [1049128] | $44 | 125% |
| Generic Commercial/Indemnity [1017001] | $44 - $251 | 125% |
| Generic Hmo [1018103] | $44 | 125% |
| Generic Ppo [1021104] | $44 | 125% |
| Medicare (plans) | $44 - $49 | 125% |
| Aetna | $49 - $203 | 140% |
| Blue Shield-Network Mcare [1006127] | $49 | 140% |
| Easy Choice Health Plan [1083113] | $49 | 140% |
| Golden State-Network Mcare [1023127] | $49 | 140% |
| Humana | $49 - $149 | 140% |
| Scan-Network Mcare [1043127] | $49 | 140% |
| UnitedHealthcare | $49 | 140% |
| Veterans Administration [1051113] | $49 | 140% |
| Contra Costa County Jail [1012104] | $149 | 425% |
| Federal Correction Institute [1062104] | $149 | 425% |
| Fortified Provider Network [1063104] | $149 | 425% |
| Galaxy Health Network [1064104] | $149 | 425% |
| Health Management Network [1066104] | $149 | 425% |
| Healthsmart - Pka Interplan [1031104] | $149 | 425% |
| Hospice Of East Bay [1085104] | $149 | 425% |
| Integrated Health Plan [1075104] | $149 | 425% |
| Medigap [1036001] | $149 | 425% |
| National Provider Network/Plancare America [1069104] | $149 | 425% |
| Networks By Design [1084104] | $149 | 425% |
| Pponext [1072104] | $149 | 425% |
| Sutter Preferred Health Plan [1044104] | $149 | 425% |
| Three Rivers Provider Network [1073104] | $149 | 425% |
| Blue Shield Hmo [1006103] | $163 | 465% |
| Blue Shield Ppo [1006104] | $163 | 465% |
| Blue Shield-Network [1006026] | $163 | 465% |
| Carelon Behavioral Health [1050104] | $186 | 530% |
| Health Net Hmo [1028103] | $186 | 530% |
| Health Net Ppo [1028104] | $186 | 530% |
| Health Net-Network [1028026] | $186 | 530% |
| Aps Healthcare [1003103] | $203 | 579% |
| Brms [1091104] | $203 | 579% |
| Delta Health Systems [1032104] | $203 | 579% |
| Empire Plan [1092104] | $203 | 579% |
| Healthcomp [1089104] | $203 | 579% |
| Kaiser Hmo [1033103] | $203 | 579% |
| Carecentrix [1011001] | $251 | 716% |
| Donor Network West [1008103] | $251 | 716% |
| Western Health Advantage Hmo [1053103] | $251 | 716% |
| Cigna | $254 | 724% |
| Beacon Health Strategies [1005103] | $271 | 773% |