Occupational therapy (therapeutic activities)
Facility: Mercy Hospital Pittsburg, Inc
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $57
- Cash Discount Price: $52
- vs. Medicare Baseline: 1.63x 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.
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 |
|---|---|---|
| Medica Contracted [320239] | $26 - $32 | 74% |
| Blue Cross Blue Shield | $28 - $69 | 80% |
| Medicaid / KanCare | $28 - $33 | 80% |
| UnitedHealthcare | $30 - $60 | 86% |
| Tricare | $31 | 88% |
| Pace Of The Ozarks Contracted [320518] | $32 | 91% |
| Medicare (plans) | $32 | 91% |
| Halo Hcr Inc Hospice Contracted [320432] | $32 | 91% |
| Dept Of Veteran Affairs Contracted [320106] | $32 | 91% |
| Aetna | $32 - $76 | 91% |
| Humana | $32 | 91% |
| Mercy Hospice Okc [20252] | $32 | 91% |
| Halo Hcr Inc Hospice [20432] | $32 | 91% |
| Elara Caring Aspire Hospice [20433] | $32 | 91% |
| Cross Timbers Hospice [20098] | $32 | 91% |
| Kindful Hospice [20434] | $32 | 91% |
| Kindful Hospice Contracted [320434] | $32 | 91% |
| Ambetter / Centene | $33 | 94% |
| Home State Health Plan Contracted [320187] | $33 | 94% |
| American Health Advantage Of Ks Mcr Contracted [320508] | $34 | 97% |
| United Medical Resources Contracted [320454] | $48 - $60 | 137% |
| Cigna | $49 - $69 | 140% |
| Health Choice Contracted [320166] | $54 | 154% |
| Ebms Contracted [320493] | $57 - $71 | 163% |
| Healthlink Contracted [320179] | $57 - $71 | 163% |
| Auxiant Contracted [320462] | $57 - $71 | 163% |
| American Healthcare Alliance Contracted [320020] | $57 - $71 | 163% |
| Edison Health Solutions Contracted [320502] | $57 - $71 | 163% |
| Workers Comp [20426] | $57 - $71 | 163% |
| Yuzu Health Contracted [320521] | $57 - $71 | 163% |
| Aither Health Contracted [320449] | $57 - $71 | 163% |
| Mercy Benefit Admin Contracted [320251] | $57 - $71 | 163% |
| Reflect Health Contracted [320492] | $57 - $71 | 163% |
| Imagine 360 Contracted [320494] | $57 - $71 | 163% |
| First Health Contracted [320128] | $60 - $76 | 171% |
| Providrs Care Network Contracted [320484] | $62 | 177% |
Consumer Guidance & Cost Commentary
For the CPT code 97530, representing occupational therapy therapeutic activities, the gross charge at Mercy Hospital Pittsburg, Inc. is $80.00. While the facility's cash median price is $52.00, which is lower than the Medicare benchmark of $35.07, patients should note that commercial insurance negotiated rates often exceed this cash price. The data shows a wide range of negotiated amounts across payers, with some plans ranging from $26 to $76, meaning that for patients with high-deductible plans, paying the cash price of $52.00 upfront could result in significant savings compared to the higher allowed amounts charged by in-network insurers.
The facility's median negotiated rate of $57.00 sits above the Medicare amount of $35.07, reflecting the typical administrative markup inherent in commercial contracts. To optimize costs, patients are encouraged to verify their specific plan's allowed amount before scheduling, as some commercial payers may allow significantly more than the cash price. Additionally, since the facility is a voluntary non-profit church-owned hospital, patients should proactively ask about self-pay or prompt-pay discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims processing.