CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Children's Nebraska

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $111
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.17x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Children's Nebraska is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.17x the Medicare baseline. Located in 8200 Dodge St, Omaha, NE.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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%)

Insurance Median: $111 (317%)

Ins. Median: $111 (317% 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 317% of the Medicare baseline (a markup of 217%). 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
Medicaid / KanCare	$31 - $90	88%
Wellpoint	$31	88%
Molina (Iowa)	$32	91%
Aetna	$45 - $175	128%
Ambetter / Centene	$91 - $139	259%
Midlands Choice Chi	$91 - $139	259%
Blue Cross Blue Shield	$94 - $159	268%
Molina (Nebraska)	$94	268%
Midlands Choice Elevate	$104 - $159	297%
Avera Health Plan	$110 - $169	314%
Centivo	$110 - $169	314%
Wellmark	$110 - $169	314%
Midlands Choice	$114 - $175	325%
Sanford Health Plan	$114 - $175	325%
UnitedHealthcare	$116 - $129	331%

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 $X.
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 Children's Nebraska 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.