CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Boston Children's Hospital

Billing Code: 97530 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$135

about 3.9× the $35 Medicare rate · typically $44–$143

modeled estimate · not a bill or quote

What this hospital charges insurers

$130

About the fair price

about $5 under the fair price · 3.7× Medicare

Medicare pays $35 Fair price $135 This hospital $130 Cash price $209 Hospital's list price $209

How we calculate the fair BaseRate →

How this hospital compares to other MA hospitals

Highest price of the 9 MA hospitals we have prices for — worth calling around.

Cheapest $36 Priciest $130

Black dot = this hospital, among the 9 MA hospitals with a price for this procedure. Full list below.

A fair price for a Occupational therapy (therapeutic activities) is about $135 (about 3.9× the $35 Medicare rate). Boston Children's Hospital charges insurers about $130, or about $209 in cash — about the fair price. Located in Boston, MA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$125 - $178	356%
Blue Cross Blue Shieldmajor	$118 - $145	336%
Aetnamajor	$125 - $175	356%
Cignamajor	$178 - $189	508%
Humanamajor	$188	536%
Ambetter (Centene)	$132	376%
CDPHP	$102 - $178	291%
Harvard Pilgrim	$106 - $141	302%
Tufts Health Plan	$128 - $129	365%
UniCare	$114	325%
+ 8 smaller / regional plans	$127 - $188

Excludes 2 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 209), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97530.

Insurance Before you use insurance

Call your insurance company to confirm Boston Children's Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 97530.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Boston Children's Hospital

Compare: Occupational therapy (therapeutic activities) at other MA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.