CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: USA Health Children's & Women's Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $78
Cash Discount Price: $147
vs. Medicare Baseline: 2.22x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at USA Health Children's & Women's Hospital is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $147. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.22x the Medicare baseline. Located in 1700 Center Street, Mobile, AL.

Cash / Self-Pay

$147

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $147 (419%)

Insurance Median: $78 (222%)

Cash: $147 (419% of Medicare)

Ins. Median: $78 (222% 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 222% of the Medicare baseline (a markup of 122%). 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
Magnolia Health	$30	86%
Truecare	$30	86%
UnitedHealthcare	$30 - $84	86%
Molina Chip	$32	91%
Blue Cross Blue Shield	$34	97%
Aetna	$35 - $86	100%
Devoted Health	$35 - $109	100%
Humana	$35 - $101	100%
Viva Health	$35 - $78	100%
Wellcare	$35	100%
Molina Marketplace	$39	111%
Ambetter / Centene	$42	120%
Mississippi Physicians Care Network (Mpcn)	$47	134%
Central Healthcare Services	$57 - $78	163%
Cigna	$62 - $150	177%
Multiplan	$84 - $109	240%
Novanet	$117 - $140	334%

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 $147.
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 USA Health Children's & Women's Hospital 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.