CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Claiborne Memorial Medical Center
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $105
- Cash Discount Price: $122
- vs. Medicare Baseline: 2.99x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Claiborne Memorial Medical Center is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $122. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.99x the Medicare baseline. Located in 620 East College Street, Homer, LA.
Cash / Self-Pay
$122
Average discount available for prompt cash payment at this facility.
Insurance Median
$105
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: $122 (348%)
Insurance Median: $105 (299%)
Cash: $122 (348% of Medicare)
Ins. Median: $105 (299% 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 299% of the Medicare baseline (a markup of 199%). 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.
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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 | $9 - $90 | 26% |
| Amerihealth Caritas La | $9 - $59 | 26% |
| Community Health Solution | $9 - $59 | 26% |
| Correctcare Intergrated | $9 - $59 | 26% |
| Healthy Blue | $9 - $59 | 26% |
| Humana | $9 - $138 | 26% |
| Louisiana Hc Connections | $9 - $59 | 26% |
| Magellan Services | $9 - $59 | 26% |
| Medicaid / KanCare | $9 - $59 | 26% |
| UnitedHealthcare | $9 - $59 | 26% |
| Ambetter / Centene | $22 | 63% |
| Arcadian Community Mcr Hm | $32 | 91% |
| Blue Cross Blue Shield | $32 - $96 | 91% |
| Champus | $32 | 91% |
| Champva | $32 | 91% |
| Cigna | $32 - $104 | 91% |
| Healthy Blue Dual Adv | $32 | 91% |
| Kaiser Foundation Health | $32 | 91% |
| Medicare (plans) | $32 | 91% |
| Peoples Health Network | $32 | 91% |
| Pyramid Claims Mcr Hmo | $32 | 91% |
| Sterling Connect 2 | $32 | 91% |
| Sterling Premier Mc Hmo | $32 | 91% |
| Superior Health Mcr Hmo | $32 | 91% |
| Tenet Mcr Hmo | $32 | 91% |
| Tricare | $32 | 91% |
| United Hc Mcr Hmo | $32 | 91% |
| Universal Hc Mcr Hmo | $32 | 91% |
| Us Dept Of Labor | $32 | 91% |
| Vantage Health Mcr Hmo | $32 | 91% |
| Windsor Sterling Mcr Hmo | $32 | 91% |
| Wps Mvh Vapc3 | $32 | 91% |
| Vantage Health Plan Inc | $36 - $40 | 103% |
| Commercial Insurance | $42 - $138 | 120% |
| Meritain Health | $42 - $90 | 120% |
| Sedgwick Claims Mgmt Serv | $44 - $124 | 125% |
| Workman'S Comp | $44 - $124 | 125% |
| Coventry Healthcare | $63 - $83 | 180% |
| Geha | $74 - $97 | 211% |
| Health Plus Of La | $74 - $104 | 211% |
| Apwu Healthplan | $79 - $104 | 225% |
| Great West Healthcare | $79 - $104 | 225% |
| Phcs | $84 - $110 | 240% |
| Ppo Plus | $84 - $110 | 240% |
| Aarp | $105 - $138 | 299% |
| Accordia National | $105 - $138 | 299% |
| Aflac | $105 - $138 | 299% |
| Alameda Alliance Forhealt | $105 - $138 | 299% |
| American Pioneer | $105 - $138 | 299% |
| Benefit Management | $105 - $138 | 299% |
| Benesys Inc | $105 - $138 | 299% |
| Business Guarantor | $105 - $138 | 299% |
| Chubb | $105 - $138 | 299% |
| Commercial Sr. Care | $105 - $138 | 299% |
| Employee Benefit Services | $105 - $138 | 299% |
| Family Life Insurance Co | $105 - $138 | 299% |
| Farm Bureau Insurance | $105 - $138 | 299% |
| Fiserv Health Benefit | $105 - $138 | 299% |
| Gmp | $105 - $138 | 299% |
| Group And Pension Admin | $105 - $138 | 299% |
| Group Resources | $105 - $138 | 299% |
| Haik Minvielle And Grubbs | $105 - $138 | 299% |
| Harrington Benefit Svs | $105 - $138 | 299% |
| Health Design Plus | $105 - $138 | 299% |
| Health Plan | $105 - $138 | 299% |
| Healthscope Benefits | $105 - $138 | 299% |
| Insurance Management Admi | $105 - $138 | 299% |
| Jefferson National | $105 - $138 | 299% |
| John Alden Health Ins | $105 - $138 | 299% |
| John Hancock | $105 - $138 | 299% |
| Liberty Mutual | $105 - $138 | 299% |
| Mailhandlers Benefit Plan | $105 - $138 | 299% |
| Manhattan Life Ins Co | $105 - $138 | 299% |
| Mega Life And Health | $105 - $138 | 299% |
| Msa Careguard | $105 - $138 | 299% |
| Mutual Of Omaha | $105 - $138 | 299% |
| Nalc Health Benefit Plan | $105 - $138 | 299% |
| Naphcare Inc. | $105 - $138 | 299% |
| New Era Life Ins Co | $105 - $138 | 299% |
| Physicians Mutual | $105 - $138 | 299% |
| Principal Financial Group | $105 - $138 | 299% |
| Prudential Healthcare | $105 - $138 | 299% |
| Self Pay | $105 - $138 | 299% |
| State Farm | $105 - $138 | 299% |
| State Farm Insurance | $105 - $138 | 299% |
| State Mutual Insurance Co | $105 - $138 | 299% |
| Sterling Investors Life | $105 - $138 | 299% |
| Tower Life | $105 - $138 | 299% |
| Transamerica Premier Ins | $105 - $138 | 299% |
| United American | $105 - $138 | 299% |
| United Comm Travelers | $105 - $138 | 299% |
| United Teachers | $105 - $138 | 299% |
| Usable Administrator | $105 - $138 | 299% |
| Visn 16 Cfu | $105 - $138 | 299% |
| Wausau Benefits | $105 - $138 | 299% |
| Webtpa | $105 - $138 | 299% |
| Wells Fargo | $105 - $138 | 299% |
| Woodmen Of The World | $105 - $138 | 299% |