CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Roxborough Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $38
Cash Discount Price: $36
vs. Medicare Baseline: 1.08x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Roxborough Memorial Hospital is $38. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.08x the Medicare baseline. Located in 5800 Ridge Ave, Philadelphia, PA.

Cash / Self-Pay

$36

Average discount available for prompt cash payment at this facility.

Insurance Median

$38

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: $36 (103%)

Insurance Median: $38 (108%)

Cash: $36 (103% of Medicare)

Ins. Median: $38 (108% 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
Health Partners Plan	$13 - $54	37%
Medicaid / KanCare	$13	37%
Keystone	$14 - $38	40%
UnitedHealthcare	$15 - $40	43%
Humana	$29	83%
Blue Cross Blue Shield	$36 - $93	103%
Medicare (plans)	$36 - $38	103%
Pa Health & Wellness	$36 - $43	103%
Tricare	$36	103%
Providers Partner Health Plan	$37	106%
Spartan	$38	108%
Auto Insurance	$40	114%
Worker Compensation	$41	117%
Employer Direct Healthcare	$51	145%
Naphcare	$56	160%
Highmark	$75	214%
Cigna	$180	513%

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 $36.
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 Roxborough Memorial 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.