Occupational therapy (therapeutic activities)
Facility: Northwest Health - Porter
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $118
- Cash Discount Price: $95
- vs. Medicare Baseline: 3.36x 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 336% of the Medicare baseline (a markup of 236%). 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 |
|---|---|---|
| UnitedHealthcare | $30 - $186 | 86% |
| Tricare | $31 | 88% |
| Aetna | $33 - $154 | 94% |
| Blue Cross Blue Shield | $33 - $186 | 94% |
| Healthy Indiana Plan | $33 | 94% |
| Humana | $33 - $186 | 94% |
| Medicare (plans) | $33 - $35 | 94% |
| Node Hospice Non Par Agree | $33 | 94% |
| Node Mhs Mcr Adv | $33 | 94% |
| Node Va | $33 | 94% |
| One Call | $33 | 94% |
| Veterans Eval Services | $33 | 94% |
| Node Devoted Health Mcr Adv | $34 | 97% |
| Care Improvement Plus | $35 | 100% |
| In Dept Of Correction | $35 | 100% |
| Align Network | $54 | 154% |
| Node Us Dept Of Labor | $54 | 154% |
| One Call Work Comp | $54 | 154% |
| Encore Health | $60 - $242 | 171% |
| Prime Health | $60 - $227 | 171% |
| Indiana Work Comp | $67 | 191% |
| Lutheran Preferred | $67 - $182 | 191% |
| Managed Health Services | $67 - $186 | 191% |
| Lutheran Preferred Chs Employees | $73 | 208% |
| Node Encore Kba Epo | $80 | 228% |
| Porter County | $80 | 228% |
| Preferred Network Access | $80 | 228% |
| Self Pay | $82 - $109 | 234% |
| Cigna | $84 | 240% |
| Magnacare Ma | $85 | 242% |
| Physicians Health Plan | $116 | 331% |
| Network Synergy Group | $125 | 356% |
| Php Freedom | $125 | 356% |
| Sagamore Health Network | $134 - $179 | 382% |
| First Health Coventry | $148 | 422% |
| Encore Ppo | $152 | 433% |
| Caresource | $186 | 530% |
| Medicaid / KanCare | $186 | 530% |
| Mhs | $186 | 530% |
| Southeastem Indiana Health Operations | $212 - $227 | 605% |
| Multiplan/Phcs | $255 | 727% |