Occupational therapy (therapeutic activities)
Facility: The Medical Center of Southeast Texas
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $119
- Cash Discount Price: $312
- vs. Medicare Baseline: 3.39x 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 339% of the Medicare baseline (a markup of 239%). 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 |
|---|---|---|
| Medicaid / KanCare | $9 - $28 | 26% |
| Community Health Choice | $17 - $41 | 48% |
| Amerigroup | $23 - $44 | 66% |
| Community Health Choice Uhrip | $23 - $27 | 66% |
| Harbor Hospice | $23 - $27 | 66% |
| Texas Childrens Health Plan | $23 - $28 | 66% |
| Molina Healthcare | $24 - $47 | 68% |
| UnitedHealthcare | $24 - $131 | 68% |
| Beacon Health | $26 - $31 | 74% |
| Medsolutions | $31 | 88% |
| Humana | $33 - $213 | 94% |
| Caresact | $34 | 97% |
| Employer Direct Healthcare | $34 - $43 | 97% |
| Healthspring | $34 | 97% |
| Hospice | $34 | 97% |
| Medicare (plans) | $34 | 97% |
| Provider Partners Health Plan | $34 | 97% |
| Rice Land Hospice | $34 | 97% |
| Selectcare | $34 | 97% |
| Superior Healthplan | $34 - $50 | 97% |
| Texas Medical Management Partners | $34 - $43 | 97% |
| Tihp (Texas Independence Health Plan) | $34 | 97% |
| Tricare | $34 | 97% |
| Triwest | $34 | 97% |
| Blue Cross Blue Shield | $36 - $226 | 103% |
| Cccn Pro Advantage | $36 | 103% |
| Wellcare Of Texas | $36 | 103% |
| League Medical Concepts | $37 | 106% |
| Wellpath | $38 | 108% |
| Self Pay Emergent | $43 - $50 | 123% |
| Corporate Remedies | $51 | 145% |
| Elap Services | $67 | 191% |
| Texas Workers Compensation | $69 | 197% |
| Cigna | $116 - $235 | 331% |
| Dept Of Assistive And Rehabilitative Services | $144 - $168 | 411% |
| Aetna | $168 - $222 | 479% |
| Iasis Employees | $173 - $201 | 493% |
| Magellan Behavioral Health | $173 - $201 | 493% |
| First Health | $202 - $235 | 576% |
| Galaxy Health Network | $202 - $235 | 576% |
| Private Healthcare Systems | $202 - $235 | 576% |
| Texas Municipal League | $202 - $235 | 576% |
| Healthsmart | $217 - $252 | 619% |
| Multiplan | $231 - $269 | 659% |
| Commercial Non-Contracted | $289 - $336 | 824% |
| Heart To Heart Hospice | $289 - $336 | 824% |
| Lifesynch | $289 - $336 | 824% |
| Mhnet | $289 - $336 | 824% |
| Self Pay - Mcd Pending 100 Percent | $289 - $336 | 824% |
| Single Case Agreement | $289 - $336 | 824% |
| United Behavioral Health | $289 - $336 | 824% |