Occupational therapy (therapeutic activities)
Facility: Valley Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $106
- Cash Discount Price: $146
- vs. Medicare Baseline: 3.02x 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 302% of the Medicare baseline (a markup of 202%). 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 |
|---|---|---|
| Humana | $40 | 114% |
| UnitedHealthcare | $40 - $106 | 114% |
| Regence Blue Shield [170100] | $52 - $55 | 148% |
| Regence Uniform [130111] | $52 | 148% |
| Bh United [180100] | $55 | 157% |
| Blue Cross Blue Shield | $55 | 157% |
| Regence Hma [170105] | $55 | 157% |
| Regence Hma1 [170102] | $55 | 157% |
| Aetna | $94 | 268% |
| Benefit Md [150113] | $106 | 302% |
| Carpenters Trust [150122] | $106 | 302% |
| Cement Masons And Plasterers [150127] | $106 | 302% |
| Coresource [150109] | $106 | 302% |
| Employee Benefit Management Services [150108] | $106 | 302% |
| Fc Moda Health [150139] | $106 | 302% |
| First Choice Health Administrators [150110] | $106 | 302% |
| First Choice Health Comp [150112] | $106 | 302% |
| First Choice [150134] | $106 | 302% |
| Health Net [150111] | $106 | 302% |
| Here [150114] | $106 | 302% |
| Hotel Employees Health Trust [150115] | $106 | 302% |
| International Longshore & Warehouse Union [150116] | $106 | 302% |
| Kitsap Physician Services [150118] | $106 | 302% |
| Loomis Benefits West [150119] | $106 | 302% |
| Mega [150120] | $106 | 302% |
| Midwest [150121] | $106 | 302% |
| Nw Administrators [150123] | $106 | 302% |
| Operating Engineers [150125] | $106 | 302% |
| Painters Trust [150126] | $106 | 302% |
| Puget Sound Electric [150131] | $106 | 302% |
| Seattle Plumb And Pipe [150132] | $106 | 302% |
| Trusteed Plan [150101] | $106 | 302% |
| United Employee Benefit Trust [150137] | $106 | 302% |
| Washington Bakers Trust [150102] | $106 | 302% |
| Washington Employers Trust [150103] | $106 | 302% |
| Washington State Health Ins Pool [150104] | $106 | 302% |
| Welfare Pension Administration Services [150105] | $106 | 302% |
| Zenith Admin [150106] | $106 | 302% |
| Zzjohn Alden [150117] | $106 | 302% |
| Zzprincipal Financial Group [150128] | $106 | 302% |
| Zzprovidence [150129] | $106 | 302% |