CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Sanford Vermillion Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $112
Cash Discount Price: $127
vs. Medicare Baseline: 3.19x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Sanford Vermillion Medical Center is $112. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.19x the Medicare baseline. Located in 20 South Plum Street, Vermillion, SD.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$112

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: $127 (362%)

Insurance Median: $112 (319%)

Cash: $127 (362% of Medicare)

Ins. Median: $112 (319% 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 319% of the Medicare baseline (a markup of 219%). 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
Sanford Health Plan Align	$47	134%
Wellmark Sd	$48	137%
Aetna	$52 - $138	148%
Health Partners	$52 - $119	148%
Medicare (plans)	$52	148%
Ucare	$52 - $140	148%
UnitedHealthcare	$52 - $133	148%
Primewest	$53	151%
Sanford Health Plan	$63 - $84	180%
Security Health Plan	$87	248%
Medica	$131 - $140	374%
Wellmark	$137 - $138	391%
First Choice Health Network	$143	408%
Healthez	$143	408%
Multiplan	$143	408%

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 $127.
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 Sanford Vermillion Medical Center 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.