CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Seattle Children's Hospital
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $170
- Cash Discount Price: $200
- vs. Medicare Baseline: 4.85x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Seattle Children's Hospital is $170. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $200. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.85x the Medicare baseline. Located in 4800 Sand Point Way Ne, Po Box C-5371, Seattle, WA.
Cash / Self-Pay
$200
Average discount available for prompt cash payment at this facility.
Insurance Median
$170
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: $200 (570%)
Insurance Median: $170 (485%)
Cash: $200 (570% of Medicare)
Ins. Median: $170 (485% 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 485% of the Medicare baseline (a markup of 385%). 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.
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 |
|---|---|---|
| Child Hearing League [17301] | $21 | 60% |
| Hospice [17306] | $21 | 60% |
| Maple Lane School [17309] | $21 | 60% |
| Medicaid / KanCare | $21 | 60% |
| Chpw [15802] | $22 | 63% |
| Coordinated Care [15815] | $22 | 63% |
| Eye Quest [15894] | $22 | 63% |
| Icw Wellpoint [15822] | $22 | 63% |
| Kaiser [15818] | $22 | 63% |
| Molina [15809] | $22 | 63% |
| Opticare [15895] | $22 | 63% |
| UnitedHealthcare | $22 - $170 | 63% |
| Wellpoint [15814] | $22 | 63% |
| Ubh Community & State [15819] | $27 | 77% |
| Usfhp [12208] | $82 | 234% |
| Asuris [11913] | $108 | 308% |
| Bridgespan Health Company [11906] | $108 | 308% |
| Premera [11600] | $108 - $166 | 308% |
| Regence [11903] | $108 - $166 | 308% |
| Regence [11909] | $108 | 308% |
| Chpw Cascade [12228] | $110 | 314% |
| Coordinated Care [12267] | $110 - $150 | 314% |
| Kaiser [13400] | $110 - $150 | 314% |
| Kaiser [13401] | $130 | 371% |
| Regence Ump [12263] | $130 | 371% |
| Administrators [13102] | $150 - $170 | 428% |
| Molina Marketplace [12831] | $150 | 428% |
| Asuris [11900] | $166 | 473% |
| Blue Cross Blue Shield | $166 | 473% |
| Aetna | $168 | 479% |
| Ameriben [11006] | $168 | 479% |
| Christian Brothers [11001] | $168 | 479% |
| Coresource [11004] | $168 | 479% |
| Ebms [11003] | $168 | 479% |
| Meritain [12251] | $168 - $190 | 479% |
| Moda [11009] | $168 | 479% |
| Preferred One [11008] | $168 | 479% |
| Web Tpa [11007] | $168 | 479% |
| Allegiance [12264] | $170 | 485% |
| Allied [13129] | $170 | 485% |
| Assurant Health Fc [13135] | $170 | 485% |
| Carpenters Trust [13100] | $170 | 485% |
| Cigna | $170 | 485% |
| Coastal Administrative [13140] | $170 | 485% |
| Coventry Fc [13112] | $170 | 485% |
| Ebms Fc [13144] | $170 | 485% |
| First Choice [13399] | $170 | 485% |
| Guardian Fc [13105] | $170 | 485% |
| Health Alliance [13233] | $170 | 485% |
| Ilwu-Pma [13158] | $170 | 485% |
| Kps [13109] | $170 | 485% |
| Loomis Benefits West [13161] | $170 | 485% |
| Mega Life [13111] | $170 | 485% |
| Meritain Health [13229] | $170 | 485% |
| Moda Fc [13219] | $170 | 485% |
| Myers Stevens & Toohey [13169] | $170 | 485% |
| Pacific Underwriters [13175] | $170 | 485% |
| Personify Fc [13155] | $170 | 485% |
| Personify [12270] | $170 | 485% |
| Principal Mutual Fc [13115] | $170 | 485% |
| Providence Health Plan [12289] | $170 | 485% |
| Providence Health Plan [13181] | $170 | 485% |
| Psew [13124] | $170 | 485% |
| Rehn & Associates [13182] | $170 | 485% |
| Sound Health And Wellness [13116] | $170 | 485% |
| Starmark [13103] | $170 | 485% |
| Tongass Timber Trust [13202] | $170 | 485% |
| Trusteed Plans [13186] | $170 | 485% |
| Trustmark Life Insurance [13203] | $170 | 485% |
| Tufts Health Plan [12279] | $170 | 485% |
| Welfare Pension [13120] | $170 | 485% |
| Wship [13121] | $170 | 485% |
| Zenith American Solutions [13195] | $170 | 485% |
| Zenith [13123] | $170 | 485% |
| United Behavioral Health [12234] | $176 | 502% |
| Coastal Admin Svcs Contracted [12222] | $180 | 513% |
| Personify Contracted [12205] | $180 | 513% |
| Claritev [12299] | $190 | 542% |
| Ebms [12241] | $190 | 542% |
| Health Alliance [12266] | $190 | 542% |
| Humana | $190 | 542% |
| Key Benefit Admin [12276] | $190 | 542% |
| Medical Mutual [12233] | $190 | 542% |
| Moda [12842] | $190 | 542% |
| Nippon Life Insurance [12232] | $190 | 542% |
| Pehp [12235] | $190 | 542% |
| Preferredone Admin Services [12236] | $190 | 542% |
| Select Health [12277] | $190 | 542% |
| Altius Health Plan [12275] | $192 | 547% |
| Coventry Mhbp [12272] | $192 | 547% |
| Coventry [12244] | $192 | 547% |
| First Health [12210] | $192 | 547% |
| Hcc Medical [12274] | $192 | 547% |
| Lewermark [12286] | $192 | 547% |
| Medishare [12287] | $192 | 547% |
| Pacificsource [12245] | $192 | 547% |
| Rural Carrier Benefit Plan [12271] | $192 | 547% |