Occupational therapy (therapeutic activities)
Facility: Mercy Specialty Hospital Southeast Kansas
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $70
- Cash Discount Price: $91
- vs. Medicare Baseline: 2.00x 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 |
|---|---|---|
| Medicaid / KanCare | $22 - $32 | 63% |
| First Health Contracted [320128] | $26 | 74% |
| Aetna | $26 - $32 | 74% |
| Blue Cross Blue Shield | $28 - $37 | 80% |
| UnitedHealthcare | $30 - $130 | 86% |
| Medical Associates Health Contracted [320444] | $32 | 91% |
| Kindful Hospice [20434] | $32 | 91% |
| Mercy Hospice Okc [20252] | $32 | 91% |
| Tricare | $32 | 91% |
| Humana | $32 - $33 | 91% |
| Mercy Mgd Behavioral Health Contracted [320259] | $32 | 91% |
| Halo Hcr Inc Hospice Contracted [320432] | $32 | 91% |
| Halo Hcr Inc Hospice [20432] | $32 | 91% |
| Elara Caring Aspire Hospice [20433] | $32 | 91% |
| Centivo Contracted [320505] | $32 | 91% |
| Pace Of The Ozarks Contracted [320518] | $32 | 91% |
| Cross Timbers Hospice [20098] | $32 | 91% |
| Cherokee Nation Health Serv Contracted [320066] | $32 | 91% |
| Medicare (plans) | $32 | 91% |
| Kindful Hospice Contracted [320434] | $32 | 91% |
| Qual Choice Contracted [320325] | $32 | 91% |
| Cigna | $32 - $108 | 91% |
| Globalhealth Contracted [320145] | $32 | 91% |
| Dept Of Veteran Affairs Contracted [320106] | $33 | 94% |
| Provider Partners Health Plans Contracted [320450] | $34 | 97% |
| Medica Contracted [320239] | $51 | 145% |
| Providrs Care Network Contracted [320484] | $62 | 177% |
| Point C Contracted [320238] | $70 - $105 | 200% |
| Mercy Benefit Admin Contracted [320251] | $84 - $98 | 240% |
| Show-Me Health Administrators Contracted [320483] | $84 | 240% |
| Aither Health Contracted [320449] | $98 | 279% |
| Reflect Health Contracted [320492] | $98 | 279% |
| Auxiant Contracted [320462] | $98 - $105 | 279% |
| Yuzu Health Contracted [320521] | $98 | 279% |
| Edison Health Solutions Contracted [320502] | $98 | 279% |
| Imagine 360 Contracted [320494] | $98 | 279% |
| Ebms Contracted [320493] | $98 | 279% |
| American Healthcare Alliance Contracted [320020] | $98 | 279% |
| United Medical Resources Contracted [320454] | $102 - $105 | 291% |
| Benefit Management Contracted [320052] | $105 | 299% |
| Healthscope Contracted [320182] | $105 | 299% |
| Healthlink Contracted [320179] | $105 | 299% |
| Health Systems Inc Contracted [320174] | $105 | 299% |
| Preferred Health Plan Contracted [320522] | $105 | 299% |
| Insurance System Inc Contracted [320465] | $105 | 299% |
| Federal Medical Center Contracted [320127] | $105 | 299% |
| Compcare Of The Ozarks Contracted [320437] | $111 | 317% |
| Workers Comp [20426] | $112 | 319% |
| Private Health Care Systems Contracted [320320] | $130 | 371% |
| Multiplan [20270] | $133 | 379% |
| Multiplan Contracted [320270] | $133 | 379% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service at Mercy Specialty Hospital Southeast Kansas, the facility's cash price of $91.00 is notably higher than the state average of $83.00. While the facility's negotiated rates for commercial payers generally range from $22 to $133, many contracts cap payments significantly below the cash price; for instance, Medicaid / KanCare plans pay as low as $22, and several contracted plans pay exactly $32. This disparity highlights that for patients with high-deductible plans, paying the cash price of $91.00 upfront might be more cost-effective than relying on insurance, which could result in a higher allowed amount if the patient has not yet met their deductible. Patients are encouraged to verify their specific plan's allowed amount before scheduling and to explicitly request "self-pay" or "prompt-pay" discounts from the hospital, which can reduce the final bill by 20% to 50% when paid in full.
When evaluating the facility's pricing against federal standards, the Medicare rate for this service is $35.07, which serves as a critical benchmark for understanding the true cost of care. The facility's cash price of $91.00 represents a markup of approximately 2.0 times the Medicare rate, while the median negotiated rate across all payers is $70.00. It is important to note that the gross chargemaster price of $140.00 is not a reliable benchmark for comparison, as it includes administrative overhead and profit margins that are inflated for commercial billing. To ensure you are receiving fair pricing, patients should request an itemized bill to review specific