CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Riverview Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $147
Cash Discount Price: $45
vs. Medicare Baseline: 4.19x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Riverview Medical Center is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.19x the Medicare baseline. Located in One Riverview Plaza, Red Bank, NJ.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$147

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: $45 (128%)

Insurance Median: $147 (419%)

Cash: $45 (128% of Medicare)

Ins. Median: $147 (419% 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 419% of the Medicare baseline (a markup of 319%). 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
Aetna	$27 - $147	77%
Clover	$34	97%
Blue Cross Blue Shield	$41	117%
Seoul Medical Group	$41	117%
Amerigroup	$45	128%
Vaccn	$45	128%
United Community/Americhoice	$47	134%
UnitedHealthcare	$54 - $382	154%
Horizon	$60 - $152	171%
Karna	$61	174%
Horizon - Jri@Rmc	$134	382%
Qualcare	$146 - $306	416%
Cigna	$150 - $180	428%
Activecare First McO	$160	456%
Multiplan - PHCS	$160	456%
Amerihealth	$163 - $184	465%
Wellcare	$224	639%
Bergen Risk	$291	830%
Brighton Health Plan	$355	1012%
Oxford	$464	1323%

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 $45.
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 Riverview Medical Center 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.