CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Albany Medical Center Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $48
Cash Discount Price: $59
vs. Medicare Baseline: 1.37x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Albany Medical Center Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.37x the Medicare baseline. Located in 43 New Scotland Avenue, Mail Code 34, Albany, NY.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$48

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: $59 (168%)

Insurance Median: $48 (137%)

Cash: $59 (168% of Medicare)

Ins. Median: $48 (137% 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
Aetna	$10 - $260	29%
UnitedHealthcare	$16 - $128	46%
Cdphp	$23 - $214	66%
Medicare (plans)	$25 - $37	71%
Fidelis	$26 - $214	74%
Nascentia Health Options	$27 - $168	77%
Blue Cross Blue Shield	$28 - $214	80%
Tricare	$28 - $34	80%
Blue Shield Highmark	$30 - $78	86%
Emblem	$30 - $269	86%
Hamaspik	$31 - $223	88%
Mvp	$35 - $95	100%
Emblem Health Ghi	$37 - $73	106%
Nascentia	$37	106%
Blue Shield	$39 - $283	111%
Empire Plan Nyship	$40 - $128	114%
Magnacare	$40 - $128	114%
Multiplan	$42 - $136	120%
Cigna	$55 - $66	157%
Emblem_Ghi	$82 - $358	234%
Nys Department Of Corrections	$87	248%
Mvp Commercial	$121 - $296	345%
Mvp Essential Plan	$204	582%

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 $59.
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 Albany Medical Center 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.