Occupational therapy (therapeutic activities)
Facility: Shirley Ryan Abilitylab
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $156
- Cash Discount Price: $159
- vs. Medicare Baseline: 4.45x 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 445% of the Medicare baseline (a markup of 345%). 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 |
|---|---|---|
| Aetna | $35 - $110 | 100% |
| Health Care Services Corporation | $35 - $127 | 100% |
| Humana | $35 | 100% |
| Tricare | $35 | 100% |
| UnitedHealthcare | $35 - $135 | 100% |
| Wellcare Meridian Fide | $35 | 100% |
| Advocate Health Partners | $36 | 103% |
| Blue Cross Blue Shield | $76 - $123 | 217% |
| County Care | $76 | 217% |
| Meridian Health Plan | $76 | 217% |
| Hfn | $130 - $238 | 371% |
| Uic Physician Group-Campuscare | $132 - $146 | 376% |
| Corvel Corporation | $134 | 382% |
| Coventry Workers Comp | $134 | 382% |
| Multiplan | $134 | 382% |
| Paradigm Health Corporation | $136 | 388% |
| Personalcare Insurance Of Il/Firsthealth Grp Corp/Coventryhealth And Life Insurance Co | $136 - $225 | 388% |
| State Of Illinois | $136 - $141 | 388% |
| Uic Physician Group | $146 - $215 | 416% |
| Union Health Service | $148 | 422% |
| Cigna | $152 - $163 | 433% |
| Affordable Health Care Concepts | $159 | 453% |
| Loyola University Physician Foundation | $172 | 490% |
| University Of Chicago Practice Plan | $172 | 490% |
| Health Care Services Corporation Dba Managed Care Network Preferred | $180 - $236 | 513% |
| Advocate And Advocate Health Partners | $186 | 530% |
| Gallagher Benefit Administrators | $199 | 567% |
| Health Care Services Corporation D/B/A Hmo Illinois | $207 | 590% |
| Unicare Life And Health Insurance | $207 | 590% |
| Private Healthcare Systems | $212 | 605% |
| Resurrection Health Care Preferred | $212 | 605% |
| Cofinity Aka Ppom | $225 | 642% |
| Health Payors Organization | $225 | 642% |
| Healthnetwork | $233 - $252 | 664% |