Occupational therapy (therapeutic activities)
Facility: Northwest Health - Starke
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $149
- Cash Discount Price: $81
- vs. Medicare Baseline: 4.25x 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 425% of the Medicare baseline (a markup of 325%). 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 - $214 | 94% |
| Blue Cross Blue Shield | $33 - $186 | 94% |
| Humana | $33 - $186 | 94% |
| Managed Health Services | $33 - $186 | 94% |
| Medicare (plans) | $33 | 94% |
| Node Champva | $33 | 94% |
| Node Hospice Non Par Agree | $33 | 94% |
| Node Va | $33 | 94% |
| One Call | $33 | 94% |
| Node Devoted Health Mcr Adv | $34 | 97% |
| In Dept Of Correction | $35 | 100% |
| Node Pphp Mcr Adv | $35 | 100% |
| Lutheran | $47 - $67 | 134% |
| Self Pay | $47 - $136 | 134% |
| Us Department Of Labor | $54 | 154% |
| Medpartners | $58 - $83 | 165% |
| Encore | $60 - $215 | 171% |
| Indiana Workers Comp | $67 | 191% |
| Lutheran Network | $67 - $217 | 191% |
| Physicians Health Plan | $71 - $102 | 202% |
| Alpha Baking | $78 - $111 | 222% |
| Encore Kba Epo | $80 | 228% |
| Magnacare Ma | $80 | 228% |
| Encore Kba Ppo | $100 | 285% |
| Php | $104 - $149 | 297% |
| Multiplan Inc | $138 - $222 | 393% |
| Caresource | $143 - $186 | 408% |
| Cigna | $143 - $205 | 408% |
| Coventry First Health | $149 - $214 | 425% |
| Sagamore Health Network | $152 - $217 | 433% |
| Community Health Alliance | $155 - $222 | 442% |
| Ppom | $162 - $232 | 462% |
| Medicaid / KanCare | $186 | 530% |
| Mhs | $186 | 530% |