CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Saint Joseph Regional Medical Center
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $67
- Cash Discount Price: $1,298
- vs. Medicare Baseline: 1.91x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Saint Joseph Regional Medical Center is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $1,298. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.91x the Medicare baseline. Located in 5215 Holy Cross Pkwy, Mishawaka, IN.
Cash / Self-Pay
$1,298
Average discount available for prompt cash payment at this facility.
Insurance Median
$67
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: $1,298 (3701%)
Insurance Median: $67 (191%)
Cash: $1,298 (3701% of Medicare)
Ins. Median: $67 (191% 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Hospice Of Marshall County | $14 - $44 | 40% |
| Hospice Of St Joseph County | $14 - $44 | 40% |
| Plain Church Group | $14 - $46 | 40% |
| UnitedHealthcare | $17 - $26,103 | 48% |
| Aetna | $19 - $21,054 | 54% |
| Blue Cross Blue Shield | $19 - $47,957 | 54% |
| Medicaid / KanCare | $19 - $26,103 | 54% |
| Notre Dame Athletic Association | $29 - $94 | 83% |
| Wc Notre Dame | $29 - $94 | 83% |
| Luminare Health (Detroit) | $30 - $102 | 86% |
| Encore Health | $31 - $106 | 88% |
| Ameriben | $32 - $102 | 91% |
| Auxiant | $33 - $29,204 | 94% |
| Indiana Criminal Justice Inst | $33 - $106 | 94% |
| Key Benefit Administrator | $33 - $29,204 | 94% |
| Western & Southern Financial Group | $33 - $106 | 94% |
| Allied Benefit Systems | $34 - $25,809 | 97% |
| Asr Health Benefits | $34 - $110 | 97% |
| Christian Brother Services | $34 - $110 | 97% |
| Cigna | $34 - $109 | 97% |
| Employee Benefit Management | $34 - $110 | 97% |
| Geha | $34 - $108 | 97% |
| Group Administrators | $34 - $109 | 97% |
| Health Partners | $34 - $109 | 97% |
| Healthscope | $34 - $108 | 97% |
| Medical Mutual | $34 - $110 | 97% |
| Medicare (plans) | $34 - $13,855 | 97% |
| Meridian Complete | $34 - $13,583 | 97% |
| Meritain | $34 - $110 | 97% |
| Mvp | $34 - $109 | 97% |
| Pace-Trinity Health | $34 - $13,583 | 97% |
| Prairie States | $34 - $109 | 97% |
| Preferred One | $34 - $110 | 97% |
| Priority Health | $34 - $109 | 97% |
| Professional Benefit Administrators | $34 - $109 | 97% |
| Rural Carrier Health Benefit Plan | $34 - $110 | 97% |
| Sagamore Health Network | $34 - $126 | 97% |
| Sisco Benefits | $34 - $109 | 97% |
| Student Insurance Cma | $34 - $108 | 97% |
| Unified Group Services | $34 - $109 | 97% |
| Webtpa | $34 - $110 | 97% |
| County Coroner | $35 - $14,127 | 100% |
| Provider Partners Health Plan Of Indiana | $37 - $14,942 | 106% |
| Goshen Preferred Network | $41 - $146 | 117% |
| Christian Brothers Holy Cross | $42 - $136 | 120% |
| Signature Care | $42 - $136 | 120% |
| Physicians Health Plan Northern Indiana Health Insurance | $50 - $41,022 | 143% |
| St Joseph County Hlth Dpt | $50 - $20,375 | 143% |
| Caresource | $52 - $21,054 | 148% |
| Bankers Life Casualty | $53 - $170 | 151% |
| Bureau Of Disability | $53 - $170 | 151% |
| Wc Align Network | $53 - $170 | 151% |
| Siho Insurance Services | $54 - $21,734 | 154% |
| Blue Benefit Administrators Of Massachusetts | $67 - $47,957 | 191% |
| Blue Care Network | $67 - $47,957 | 191% |
| Blue Distinction Transplant | $67 - $47,957 | 191% |
| Blue Shield - Ca | $67 - $47,957 | 191% |
| Blue Shield - Id (Regence) | $67 - $47,957 | 191% |
| Blue Shield - Ny Highmark Northeastern | $67 - $47,957 | 191% |
| Blue Shield - Ny Highmark Western | $67 - $47,957 | 191% |
| Blue Shield - Pa (Highmark) | $67 - $47,957 | 191% |
| Blue Shield - Wa (Regence) | $67 - $47,957 | 191% |
| Custom Design Benefits | $72 - $29,204 | 205% |
| Managed Health Services - Indiana | $186 - $26,103 | 530% |
| Mdwise | $186 - $26,103 | 530% |