Occupational therapy (therapeutic activities)
Facility: Pioneer Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $140
- Cash Discount Price: $118
- vs. Medicare Baseline: 3.99x 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 399% of the Medicare baseline (a markup of 299%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $66 - $122 | 188% |
| Health Info Net Mcr Adv | $66 | 188% |
| Healtnet Federal-All Plans | $66 | 188% |
| Humana | $66 - $135 | 188% |
| Triwest Va Pccc-All Plans | $66 | 188% |
| UnitedHealthcare | $66 - $140 | 188% |
| Rocky Mountain Health Network-All Plans | $103 | 294% |
| Allegiance Provider-All Plans | $125 | 356% |
| Mountain Health Co-Op Hpn | $129 | 368% |
| 6 Degrees Health-All Plans | $140 | 399% |
| Americas Choice-All Plans | $140 | 399% |
| City Of Billings-All Plans | $140 | 399% |
| Community Health Ntwk-All Plans | $140 | 399% |
| Ebms Select Care Network-All Plans | $140 | 399% |
| Fedmed Network-All Plans | $140 | 399% |
| First Choice Big Sky-All Plans | $140 | 399% |
| First Health-All Plans | $140 | 399% |
| Interwest Ppo | $140 | 399% |
| Mountain Health Co-Op-All Other Plans | $140 | 399% |
| Pacific Source-All Plans | $140 | 399% |
| Pacific Steel & Recycling-All Plans | $140 | 399% |
| Three Rivers-All Plans | $140 | 399% |
| Health Info Net Peak/Equity | $143 | 408% |
| Health Info Net Standard-All Other Plans | $143 | 408% |
| Mountain Health Co-Op Ppo/Pos | $144 | 411% |
| Interwest Health Traditional-All Other Plans | $147 | 419% |