CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Shriners Hospitals for Children - Philadelphia

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $36
Cash Discount Price: $578
vs. Medicare Baseline: 1.03x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Shriners Hospitals for Children - Philadelphia is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $578. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.03x the Medicare baseline. Located in 3551 N Broad Street, Philadelphia, PA.

Cash / Self-Pay

$578

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $578 (1648%)

Insurance Median: $36 (103%)

Cash: $578 (1648% of Medicare)

Ins. Median: $36 (103% 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
Ambetter / Centene	$12 - $42	34%
Humana	$12	34%
Aetna	$13 - $52	37%
Amerihealth Mercy Health Plans	$13	37%
Geisinger Health Plan	$13	37%
Health Partners Of Philadelphia	$13	37%
Keystone Mercy Health Plans	$13	37%
Upmc Health Plan	$13	37%
Blue Cross Blue Shield	$23 - $80	66%
Soonercare	$30	86%
Amerihealth Caritas Nc	$42	120%
Amerihealth Caritas Sc	$42	120%
Sana Benefits	$51	145%
Cigna	$130	371%
Providence Health Plan	$139	396%
UnitedHealthcare	$167 - $180	476%

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 $578.
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 Shriners Hospitals for Children - Philadelphia 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.