CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Tri Valley Health System

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $109
Cash Discount Price: $145
vs. Medicare Baseline: 3.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Tri Valley Health System is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $145. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.11x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$145

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $145 (413%)

Insurance Median: $109 (311%)

Cash: $145 (413% of Medicare)

Ins. Median: $109 (311% 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 311% of the Medicare baseline (a markup of 211%). 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
Blue Cross Blue Shield	$65 - $165	185%
Humana	$65 - $77	185%
Medica Mcr Adv	$65 - $77	185%
Medica Prime Sol	$65 - $77	185%
Tricare	$65 - $77	185%
Wellcare Mcr Adv - All Plans	$65 - $77	185%
Great Plains Mcr Adv - All Plans	$68 - $80	194%
Healthy Blue Mcaid - All Plans	$71 - $84	202%
Molina Mcaid - All Plans	$71 - $84	202%
Nebraska Total Care-All Plans	$71 - $84	202%
UnitedHealthcare	$71 - $167	202%
Amerigroup Mcaid - All Plans	$72 - $85	205%
Medica Chi Aco - All Other Plans	$133 - $157	379%
Medica Chi Open Access	$133 - $157	379%
Medica Ifb Aco	$133 - $157	379%
Medica Ifb Open Access	$133 - $157	379%
Midlands Choice-All Plans	$133 - $157	379%
Aetna	$145 - $171	413%
Multiplan-All Plans	$145 - $171	413%

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 $145.
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 Tri Valley Health System 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.