CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Highlands Cashiers Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $43
Cash Discount Price: $102
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Highlands Cashiers Hospital is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $102. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.23x the Medicare baseline. Located in 190 Hospital Drive, Highlands, NC.

Cash / Self-Pay

$102

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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: $102 (291%)

Insurance Median: $43 (123%)

Cash: $102 (291% of Medicare)

Ins. Median: $43 (123% 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.

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
Apex Health	$17 - $24	48%
Cigna	$28 - $53	80%
Blue Cross Blue Shield	$29 - $43	83%
United	$29 - $73	83%
Wellcare	$29 - $42	83%
Amerihealth	$30 - $43	86%
Partners Health Management	$30 - $43	86%
Vaya Health	$30 - $43	86%
Amerihealth Caritas	$32 - $46	91%
Caresource	$37 - $53	106%
Medcost	$39 - $68	111%
Aetna	$40 - $88	114%
Magellan	$50 - $72	143%
Magellan Behavioral Health	$50 - $72	143%
Multiplan	$67 - $96	191%
Avalon Administrative Services	$71 - $102	202%
Prime Health	$74 - $108	211%

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 $102.
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 Highlands Cashiers Hospital 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.