Occupational therapy (therapeutic activities)
Facility: Lancaster General Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $94
- Cash Discount Price: $112
- vs. Medicare Baseline: 2.68x 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 268% of the Medicare baseline (a markup of 168%). 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 |
|---|---|---|
| UnitedHealthcare | $14 - $98 | 40% |
| Hospice And Community Care | $21 - $22 | 60% |
| Blue Cross Blue Shield | $23 - $405 | 66% |
| Medicaid / KanCare | $25 - $65 | 71% |
| Upmc For You | $28 - $29 | 80% |
| Old Order Group | $30 - $37 | 86% |
| Tricare | $30 | 86% |
| Lg Coresource/Lg Eliance | $32 - $33 | 91% |
| Aetna | $33 - $78 | 94% |
| Albright Life | $33 | 94% |
| Coatesville Va | $33 | 94% |
| Highmark | $33 - $115 | 94% |
| Hospice Generic | $33 | 94% |
| Lancashire Hall | $33 - $115 | 94% |
| Lebanon Veterans Hospital | $33 | 94% |
| Medicare (plans) | $33 - $36 | 94% |
| Nursing Home Op Services | $33 - $34 | 94% |
| Amerihealth Caritas | $34 | 97% |
| Cigna | $34 - $96 | 97% |
| Health Partners Mcr Advantage | $34 | 97% |
| Devoted Health | $35 | 100% |
| Pa Health And Wellness Mcr | $35 | 100% |
| Affilia Home Health | $44 - $115 | 125% |
| Elap Employees | $47 | 134% |
| Masonic Homes | $47 - $115 | 134% |
| Gateway | $56 - $58 | 160% |
| Oscar Health Plan | $65 | 185% |
| Eliance Health Solutions | $71 - $74 | 202% |
| Highmark Commercial Preferred | $74 - $115 | 211% |
| Ehp | $91 - $94 | 259% |
| Upmc Commercial | $91 - $98 | 259% |
| Devon | $94 - $98 | 268% |
| Geisinger Commercial | $94 - $98 | 268% |
| Intergroup Services | $94 - $98 | 268% |
| Preferred Healthcare | $94 - $98 | 268% |
| Claim Watcher Plus | $99 | 282% |
| Medi-Share Christian Care | $105 - $109 | 299% |
| Claim Watcher | $109 | 311% |
| Commercial Generic | $111 - $115 | 317% |
| Highmark Commercial Non-Preferred | $111 - $116 | 317% |
| Magellan | $111 - $115 | 317% |
| United Behavioral Health | $111 - $115 | 317% |
| Value Options | $111 - $115 | 317% |
| Workers Compensation | $111 - $115 | 317% |
| Elap Other Groups | $121 | 345% |
| Gift Of Life Donor Program | $13,500 | 38494% |