Occupational therapy (therapeutic activities)
Facility: Fhn Memorial Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $150
- Cash Discount Price: $176
- vs. Medicare Baseline: 4.28x 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 428% of the Medicare baseline (a markup of 328%). 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 |
|---|---|---|
| Meridian Health Plan - All Plans | $31 | 88% |
| Aetna | $34 - $122 | 97% |
| Health Alliance Mcr Adv | $34 | 97% |
| Humana | $34 - $174 | 97% |
| Quartz Mcr Adv | $34 | 97% |
| UnitedHealthcare | $34 - $171 | 97% |
| The Alliance - All Plans | $52 - $132 | 148% |
| Ecoh Nihp | $54 - $138 | 154% |
| Nihp Employ - All Plans | $54 - $138 | 154% |
| Quartz - All Other Plans | $56 - $143 | 160% |
| Blue Cross Blue Shield | $58 - $148 | 165% |
| Ecoh - All Other Plans | $58 - $149 | 165% |
| Northern Il Hp - All Plans | $59 - $152 | 168% |
| First Health - All Plans | $60 - $154 | 171% |
| Health Alliance - All Other Plans | $65 | 185% |
| Hfn - All Plans | $71 - $180 | 202% |
| First Choice Il - All Plans | $73 - $187 | 208% |
| Multiplan Phcs - All Plans | $73 - $187 | 208% |
| Wps - All Plans | $75 - $192 | 214% |
| Galaxy - All Plans | $77 - $198 | 220% |
| Interplan Health - All Plans | $77 - $198 | 220% |
| Preferred Plan Ppo - All Plans | $77 - $198 | 220% |
| Trustmark - All Plans | $79 - $202 | 225% |
| Midland Choice - All Plans | $82 - $209 | 234% |
| Osf Healthplans - All Plans | $86 - $220 | 245% |