CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: NYU Langone Hospitals

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $256
Cash Discount Price: $69
vs. Medicare Baseline: 7.30x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at NYU Langone Hospitals is $256. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 7.30x the Medicare baseline. Located in 550 First Avenue, New York, NY.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$256

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: $69 (197%)

Insurance Median: $256 (730%)

Cash: $69 (197% of Medicare)

Ins. Median: $256 (730% 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 730% of the Medicare baseline (a markup of 630%). 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
Fidelis	$36 - $256	103%
Healthfirst	$36 - $256	103%
Healthplus	$36 - $256	103%
Ghi	$39 - $360	111%
Hip	$39 - $360	111%
Medicare (plans)	$39 - $40	111%
Wellcare	$39 - $40	111%
Amida	$40	114%
Centerlight	$40 - $41	114%
1199	$50	143%
Metroplus	$55 - $256	157%
Hamaspik	$59 - $60	168%
Medicaid / KanCare	$70 - $114	200%
UnitedHealthcare	$70 - $381	200%
Somos	$73 - $154	208%
Blue Cross Blue Shield	$238 - $298	679%
Oscar	$239	681%
Multiplan	$284	810%
Oxford	$308 - $358	878%
Aetna	$313 - $363	893%
Magnacare	$370 - $596	1055%
Cigna	$393	1121%

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 $69.
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 NYU Langone Hospitals 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.