CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Nell J Redfield Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $61
Cash Discount Price: $69
vs. Medicare Baseline: 1.74x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Nell J Redfield Memorial Hospital is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.74x the Medicare baseline. Located in 150 North 200 West, Malad City, ID.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

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: $69 (197%)

Insurance Median: $61 (174%)

Cash: $69 (197% of Medicare)

Ins. Median: $61 (174% 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.

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
Regence Bs Mcr	$36 - $45	103%
UnitedHealthcare	$36 - $76	103%
Aetna	$37 - $74	106%
Bc Mcr Adv	$37 - $45	106%
Choicecare Mcr Adv	$37 - $45	106%
Pacificsource Mcr Adv - All Plans	$38 - $46	108%
University Of Ut - All Plans	$58 - $72	165%
Choicecare Ppo - All Other Plans	$62 - $76	177%
Town & Country - All Plans	$62 - $76	177%
Brightpath Select Hlth - All Plans	$66 - $81	188%
Regence Bs Comm - All Other Plans	$69 - $86	197%
Bc Comm - All Other Plans	$72 - $88	205%

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 $69.
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 Nell J Redfield Memorial Hospital 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.