CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Sanford Worthington Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $80
Cash Discount Price: $117
vs. Medicare Baseline: 2.28x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Sanford Worthington Medical Center is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.28x the Medicare baseline. Located in 1018 Sixth Avenue Po Box 997, Worthington, MN.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $117 (334%)

Insurance Median: $80 (228%)

Cash: $117 (334% of Medicare)

Ins. Median: $80 (228% 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 228% of the Medicare baseline (a markup of 128%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Sanford Health Plan Align	$33	94%
Aetna	$36 - $120	103%
Blue Cross Blue Shield	$36 - $66	103%
Health Partners	$36 - $104	103%
Medicare (plans)	$36	103%
Ucare	$36 - $114	103%
UnitedHealthcare	$36 - $122	103%
Primewest	$37	106%
Sanford Health Plan	$57 - $67	163%
Security Health Plan	$80	228%
Medica	$130 - $140	371%
First Choice Health Network	$132	376%
Healthez	$132	376%
Multiplan	$132	376%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $117.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Sanford Worthington Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.