CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Mercy Hospital Fort Smith
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $42
- Cash Discount Price: $70
- vs. Medicare Baseline: 1.20x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mercy Hospital Fort Smith is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.20x the Medicare baseline. Located in 7301 Rogers Ave, Fort Smith, AR.
Cash / Self-Pay
$70
Average discount available for prompt cash payment at this facility.
Insurance Median
$42
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: $70 (200%)
Insurance Median: $42 (120%)
Cash: $70 (200% of Medicare)
Ins. Median: $42 (120% 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.
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 |
|---|---|---|
| Arkansas Department Of Health [20036] | $22 | 63% |
| Medicaid / KanCare | $22 - $48 | 63% |
| Summit Community Care Contracted [320368] | $22 | 63% |
| Summit Community Care [20368] | $22 | 63% |
| Mercy Interfacility [20513] | $24 | 68% |
| Aetna | $31 - $81 | 88% |
| American Health Advantage Of Mo Mcr [20264] | $31 | 88% |
| Blue Cross Blue Shield | $31 - $42 | 88% |
| Cherokee Nation Health Serv Contracted [320066] | $31 | 88% |
| Cross Timbers Hospice [20098] | $31 | 88% |
| Dept Of Veteran Affairs Contracted [320106] | $31 | 88% |
| Elara Caring Aspire Hospice Contracted [320433] | $31 | 88% |
| Elara Caring Aspire Hospice [20433] | $31 | 88% |
| Globalhealth Contracted [320145] | $31 | 88% |
| Halo Hcr Inc Hospice Contracted [320432] | $31 | 88% |
| Halo Hcr Inc Hospice [20432] | $31 | 88% |
| Humana | $31 - $86 | 88% |
| Independent Health [20197] | $31 | 88% |
| Jordan Valley Senior Care Pace [20515] | $31 | 88% |
| Kindful Hospice Contracted [320434] | $31 | 88% |
| Kindful Hospice [20434] | $31 | 88% |
| Medical Associates Health [20444] | $31 | 88% |
| Medicare (plans) | $31 - $33 | 88% |
| Mercy Hospice Okc [20252] | $31 | 88% |
| Pace Of The Ozarks [20518] | $31 | 88% |
| Provider Partners Health Plans Contracted [320450] | $31 | 88% |
| Qual Choice Contracted [320325] | $31 | 88% |
| Spina Bifida Hlthcare Benefit [20506] | $31 | 88% |
| Tribute Health Plan Mcr [20338] | $31 | 88% |
| Tricare | $31 | 88% |
| UnitedHealthcare | $31 - $186 | 88% |
| Valir Pace [20503] | $31 | 88% |
| Wellfirst Health Mcr [20443] | $31 | 88% |
| Cigna | $33 - $168 | 94% |
| Usable Contracted [320409] | $42 | 120% |
| Aither Health Contracted [320449] | $43 | 123% |
| Edison Health Solutions Contracted [320502] | $43 | 123% |
| Mercy Benefit Admin Contracted [320251] | $43 - $65 | 123% |
| Ambetter / Centene | $48 | 137% |
| Home State Health Plan Contracted [320187] | $48 | 137% |
| Novasys Contracted [320285] | $48 - $140 | 137% |
| Arkansas Total Care Contracted [320039] | $49 | 140% |
| Arkansas Total Care [20039] | $49 | 140% |
| Health Choice Contracted [320166] | $49 | 140% |
| 90 Degree Benefits Contracted [320436] | $54 | 154% |
| Show-Me Health Administrators Contracted [320483] | $54 | 154% |
| Auxiant Contracted [320462] | $65 - $70 | 185% |
| Ebms Contracted [320493] | $65 | 185% |
| Healthlink Contracted [320179] | $65 - $70 | 185% |
| Imagine 360 Contracted [320494] | $65 | 185% |
| Municipal Health Plan Contracted [320271] | $65 | 185% |
| Reflect Health Contracted [320492] | $65 | 185% |
| Insurance System Inc Contracted [320465] | $70 | 200% |
| Personify Health Contracted [320051] | $70 | 200% |
| Preferred Health Plan Contracted [320522] | $70 | 200% |
| Workers Comp [20426] | $70 | 200% |
| Ppo Plus Contracted [320310] | $81 | 231% |
| First Health Contracted [320128] | $83 | 237% |
| Employers Health Coalition Contracted [320116] | $85 | 242% |
| Private Health Care Systems Contracted [320320] | $86 | 245% |
| Private Health Care Systems [20320] | $86 | 245% |
| Multiplan Contracted [320270] | $92 | 262% |
| Multiplan [20270] | $92 | 262% |
| Qual Choice Contracted [320324] | $104 | 297% |
| United Medical Resources Contracted [320454] | $186 | 530% |