Occupational therapy (therapeutic activities)
Facility: Adventist Health Portland
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $124
- Cash Discount Price: $66
- vs. Medicare Baseline: 3.54x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 354% of the Medicare baseline (a markup of 254%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Ods - All Plans | $30 | 86% |
| Care Oregon - All Plans | $32 | 91% |
| Kaiser Mcr Adv | $37 | 106% |
| Humana | $38 - $40 | 108% |
| Moda Mcr Adv | $40 | 114% |
| UnitedHealthcare | $40 - $124 | 114% |
| Healthnet Mcr Adv | $43 | 123% |
| Ah Employee Health Plan - All Plans | $67 | 191% |
| Workers Comp | $71 | 202% |
| Moda Conn Oebb/Syn Pebb | $75 | 214% |
| Moda Affinity - All Other Plans | $86 | 245% |
| Kaiser - All Other Plans | $98 | 279% |
| Bc Premera First - All Plans | $103 | 294% |
| Regence Ohsu Plus | $113 | 322% |
| Healthnet Hmo/Pos - All Other Plans | $117 | 334% |
| Moda Select | $117 | 334% |
| Healthnet Epo/Pos/Ppo | $118 | 336% |
| Worldventure - All Plans | $124 | 354% |
| Regence - All Other Plans | $125 | 356% |
| Moda Connexus | $133 | 379% |
| Providence Hp - All Plans | $134 | 382% |
| Regence Preferred Mcr Adv | $134 | 382% |
| Pacific Source Comm - All Plans | $136 | 388% |
| Cigna | $139 | 396% |
| Moda Synergy | $140 | 399% |
| First Choice - All Plans | $143 | 408% |
| Multiplan - All Plans | $154 | 439% |
| Phcs - All Plans | $154 | 439% |
| Regence Mcr Adv | $157 | 448% |
| Aetna | $159 | 453% |
| First Health-Coventry - All Plans | $165 | 470% |
| National Provider Network - All Plans | $181 | 516% |
| Health Payors Organization Ltd- All Plans | $185 | 528% |
| Healthcare Resources - All Plans | $205 | 585% |
| Moda Ohsu Ppo/Epo/Hmc | $371 | 1058% |