CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Connecticut Childrens Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $278
Cash Discount Price: $80
vs. Medicare Baseline: 7.93x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Connecticut Childrens Medical Center is $278. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 7.93x the Medicare baseline. Located in 282 Washington Street, Hartford, CT.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$278

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $80 (228%)

Insurance Median: $278 (793%)

Cash: $80 (228% of Medicare)

Ins. Median: $278 (793% of 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 793% of the Medicare baseline (a markup of 693%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Harvard Pilgrim [1001134]	$96 - $573	274%
Multiplan [1001126]	$96 - $115	274%
UnitedHealthcare	$96 - $573	274%
Blue Cross Blue Shield	$99 - $104	282%
Unicare [100148]	$99 - $104	282%
Wellpoint [100150]	$99 - $104	282%
Cdphp/Comm [100199]	$111 - $115	317%
Generic Multiplan [1001130]	$111 - $115	317%
Ultrabenefits/Comm [100181]	$111 - $115	317%
Cigna	$225	642%
Great West Healthcare [100107]	$225	642%
Health Partners [110229]	$225	642%
Mvp Health Plan [100144]	$225	642%
Tufts Health Plan [100114]	$225	642%
Aetna	$254 - $345	724%
Connecticare [100105]	$278	793%
Emblem Health Commercial [1001108]	$278	793%
Medicaid / KanCare	$278	793%
1199 National Benefit Fund [100134]	$282 - $345	804%
Government Employees Hospital Assoc [100115]	$282 - $345	804%
Humana	$282 - $345	804%
Meritain Health [100149]	$282 - $345	804%
Nippon Life Ins Co Of America [100112]	$282 - $345	804%
Yale Health Plan [100162]	$282 - $345	804%
Golden Rule [100106]	$532 - $573	1517%
Oxford [100103]	$532 - $573	1517%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $80.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Connecticut Childrens Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.