CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: St Joseph's University Medical Center Inc

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97530
  • Insurance Median: $56
  • Cash Discount Price: $274
  • vs. Medicare Baseline: 1.60x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at St Joseph's University Medical Center Inc is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $274. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.60x the Medicare baseline. Located in 703 Main St, Paterson, NJ.
Cash / Self-Pay
$274

Average discount available for prompt cash payment at this facility.

Insurance Median
$56

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: $274 (781%)
Insurance Median: $56 (160%)
Cash: $274 (781% of Medicare)
Ins. Median: $56 (160% 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.

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
Fidelis Care of New Jersey $29 - $55 83%
UnitedHealthcare $29 - $343 83%
Aetna $30 - $80 86%
Blue Cross Blue Shield $37 - $239 106%
Amerihealth $39 - $174 111%
Wellpoint $39 - $54 111%
Clover Health $39 111%
Ambetter / Centene $39 - $59 111%
Horizon New Jersey Total Care $39 111%
Longevity Health Plan $45 128%
Multiplan $59 - $206 168%
Horizon New Jersey Health $65 - $119 185%
Private Healthcare Systems $91 - $178 259%
Consumer Health Network $105 - $247 299%
Cigna $139 - $274 396%
Magnacare $192 547%
Oscar $258 736%
Oxford $316 901%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 703 Main St, Paterson, NJ 07503
  • CMS Rating: ★★★☆☆
  • Ownership Type: Voluntary non-profit - Church
  • Hospital Type: Acute Care Hospitals