CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Hospital for Special Surgery

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $184
Cash Discount Price: $221
vs. Medicare Baseline: 5.25x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Hospital for Special Surgery is $184. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $221. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 5.25x the Medicare baseline. Located in 535 East 70Th Street, New York, NY.

Cash / Self-Pay

$221

Average discount available for prompt cash payment at this facility.

Insurance Median

$184

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: $221 (630%)

Insurance Median: $184 (525%)

Cash: $221 (630% of Medicare)

Ins. Median: $184 (525% 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 525% of the Medicare baseline (a markup of 425%). 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 Essential [1323]	$5	14%
Affinity By Molina Health Plan [1005]	$6 - $169	17%
Blue Cross Blue Shield	$6 - $203	17%
Connecticare [1039]	$6	17%
Emblem Health [1043]	$6 - $187	17%
Medicare (plans)	$6	17%
UnitedHealthcare	$6 - $275	17%
Oxford [1096]	$169 - $218	482%
Aetna	$184 - $204	525%
Christian Brothers [1034]	$184 - $204	525%
Meritain Health [1085]	$184 - $204	525%
Nippon Life [1092]	$184 - $204	525%
Webtpa [1356]	$184 - $204	525%
Apwu [1016]	$185	528%
Cigna	$185	528%
Nalc [1090]	$185	528%
Qualcare [1101]	$185	528%
Wellfleet [1361]	$185	528%
Student Resources [1103]	$187 - $241	533%
Harvard Pilgrim [1057]	$213 - $275	607%
Geha [1053]	$241	687%

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 $221.
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 Hospital for Special Surgery 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.