CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Crouse Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $60
Cash Discount Price: $86
vs. Medicare Baseline: 1.71x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Crouse Hospital is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.71x the Medicare baseline. Located in 736 Irving Avenue, Syracuse, NY.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $86 (245%)

Insurance Median: $60 (171%)

Cash: $86 (245% of Medicare)

Ins. Median: $60 (171% 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
Excellus	$28 - $230	80%
Aetna	$32 - $51	91%
Brighton Healthplan	$32 - $63	91%
Cdphp	$32	91%
Emblemhealth	$32	91%
Fidelis	$32 - $141	91%
Humana	$32	91%
Martins Point	$32	91%
Mvp	$32 - $141	91%
Nascentia	$32	91%
UnitedHealthcare	$32 - $235	91%
Mycompass	$33 - $65	94%
Wellcare	$34 - $75	97%
Healthfirst Health Plan	$63 - $69	180%
Molina	$63 - $141	180%
Emblem Health	$73 - $230	208%

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 $86.
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 Crouse 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.