CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Sisters of Charity Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $24
Cash Discount Price: $120
vs. Medicare Baseline: 0.68x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Sisters of Charity Hospital is $24. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $120. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 0.68x the Medicare baseline. Located in 2157 Main Street, Buffalo, NY.

Cash / Self-Pay

$120

Average discount available for prompt cash payment at this facility.

Insurance Median

$24

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: $120 (342%)

Insurance Median: $24 (68%)

Cash: $120 (342% of Medicare)

Ins. Median: $24 (68% 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
Molina Essential [100167]	$5	14%
Fidelis Essential [100163]	$5	14%
Blue Cross Blue Shield	$5 - $48	14%
No Fault [114001]	$24	68%
Workers Compensation [500101]	$24	68%
Medicaid / KanCare	$31 - $34	88%
Independent Health Essential [100166]	$31 - $41	88%
Hospice [550001]	$35	100%
Independent Health [100165]	$47 - $82	134%
Medicare (plans)	$64 - $67	182%
Iha First Choice [800001]	$67 - $74	191%

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 $120.
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 Sisters of Charity 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.