Occupational therapy (therapeutic activities)
Facility: Medstar Harbor Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $271
- Cash Discount Price: $265
- vs. Medicare Baseline: 7.73x 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 773% of the Medicare baseline (a markup of 673%). 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 | $166 - $301 | 473% |
| Amerigroup | $166 - $301 | 473% |
| Amerihealth Caritas District Of Columbia | $166 - $301 | 473% |
| Carefirst Advantage Inc | $166 - $301 | 473% |
| Carefirst Blue Choice Inc | $166 - $301 | 473% |
| Cigna | $166 - $301 | 473% |
| First Health | $166 - $301 | 473% |
| Hscsn | $166 - $301 | 473% |
| Humana | $166 - $301 | 473% |
| Kaiser Permanente | $166 - $301 | 473% |
| Magellan Behavioral Health Inc | $166 - $301 | 473% |
| Mamsi | $166 - $301 | 473% |
| Medstar Family Choice | $166 - $301 | 473% |
| Medstar Family Choice Inc | $166 - $301 | 473% |
| Ncppo Healthlink Ppo | $166 - $301 | 473% |
| Pfc | $166 - $301 | 473% |
| Private Healthcare Systems (Phcs) | $166 - $301 | 473% |
| Tricare | $166 - $301 | 473% |
| United Behavioral Health Inc | $166 - $301 | 473% |
| UnitedHealthcare | $166 - $301 | 473% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important thing to know is that the cash median rate for this service is $265. It is often financially advantageous for patients with high-deductible plans to pay this cash price, as it can be significantly lower than the negotiated rates charged to commercial insurance members. While the facility lists a gross charge of $271, commercial payers are contractually limited to a range between $166 and $301, meaning the cash price may already be at or below the lowest possible insurance payment. Patients should proactively inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can further reduce the final amount owed.
The broader pricing context shows that this facility, Medstar Harbor Hospital, is a voluntary non-profit acute care hospital in Baltimore, MD. The cash rate of $265 is comparable to the facility's own median negotiated rate of $271, indicating consistent pricing structures. While the data provided does not include specific state or county average benchmarks for comparison, the Medicare amount for this code is set at $35.07, which serves as a federal baseline for evaluating the facility's markup. Commercial rates across 20 different payers average between 4.6 and 8.6 times the Medicare amount, highlighting the significant difference between federal cost-based reimbursement and commercial market pricing.