Occupational therapy (therapeutic activities)
Facility: Mercy Hospital Columbus
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $88
- Cash Discount Price: $79
- vs. Medicare Baseline: 2.51x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 251% of the Medicare baseline (a markup of 151%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $30 - $88 | 86% |
| Blue Cross Blue Shield | $30 - $88 | 86% |
| UnitedHealthcare | $30 - $100 | 86% |
| Humana | $32 - $115 | 91% |
| Medicare (plans) | $33 - $91 | 94% |
| Health Systems Inc Contracted [320174] | $52 | 148% |
| Insurance System Inc Contracted [320465] | $52 | 148% |
| Administrative Payor Contracted [320005] | $54 | 154% |
| Globalhealth Contracted [320145] | $88 | 251% |
| Aetna | $88 - $109 | 251% |
| Medical Associates Health Contracted [320444] | $88 | 251% |
| Halo Hcr Inc Hospice [20432] | $88 | 251% |
| Cigna | $88 | 251% |
| Cherokee Nation Health Serv Contracted [320066] | $88 | 251% |
| Indian Health Service Contracted [320198] | $88 | 251% |
| Novasys Contracted [320285] | $88 | 251% |
| Mercy Hospice Okc [20252] | $88 | 251% |
| Kindful Hospice Contracted [320434] | $88 | 251% |
| Qual Choice Contracted [320325] | $88 | 251% |
| Provider Partners Health Plans Contracted [320450] | $88 | 251% |
| Centurion Of Missouri [20459] | $88 | 251% |
| Home State Health Plan Contracted [320187] | $88 | 251% |
| Ambetter / Centene | $88 | 251% |
| Dept Of Veteran Affairs Contracted [320106] | $88 | 251% |
| Tricare | $88 | 251% |
| Mercy Mgd Behavioral Health Contracted [320259] | $88 | 251% |
| Cross Timbers Hospice [20098] | $88 | 251% |
| Pace Of The Ozarks Contracted [320518] | $88 | 251% |
| Halo Hcr Inc Hospice Contracted [320432] | $88 | 251% |
| Elara Caring Aspire Hospice [20433] | $88 | 251% |
| Kindful Hospice [20434] | $88 | 251% |
| Healthscope Contracted [320182] | $93 | 265% |
| Workers Comp [20426] | $97 - $103 | 277% |
| United Medical Resources Contracted [320454] | $100 - $115 | 285% |
| Medica Contracted [320239] | $108 | 308% |
| Preferred Health Plan Contracted [320522] | $109 | 311% |
| American Healthcare Alliance Contracted [320020] | $109 | 311% |
| Federal Medical Center Contracted [320127] | $109 | 311% |
| Usa Managed Care Org Contracted [320429] | $109 | 311% |
| Healthlink Contracted [320179] | $109 - $115 | 311% |
| First Health Contracted [320128] | $109 | 311% |
| Mercy Benefit Admin Contracted [320251] | $109 - $115 | 311% |
| Auxiant Contracted [320462] | $115 | 328% |
| Reflect Health Contracted [320492] | $115 | 328% |
| Yuzu Health Contracted [320521] | $115 | 328% |
| Aither Health Contracted [320449] | $115 | 328% |
| Ebms Contracted [320493] | $115 | 328% |
| 90 Degree Benefits Contracted [320436] | $115 | 328% |
| Point C Contracted [320238] | $115 | 328% |
| Private Health Care Systems Contracted [320320] | $115 | 328% |
| Imagine 360 Contracted [320494] | $115 | 328% |
| Ppo Plus Contracted [320310] | $115 | 328% |
| Benefit Management Contracted [320052] | $115 | 328% |
| Show-Me Health Administrators Contracted [320483] | $115 | 328% |
| Edison Health Solutions Contracted [320502] | $115 | 328% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service (CPT 97530) at Mercy Hospital Columbus, the facility's cash price of $79.00 is notably lower than the state average of $97.00 and significantly below the gross charge of $121.00. While many commercial payers negotiate rates ranging from $30 to $115, the cash rate offers a potential savings for patients with high-deductible plans or those without insurance, as the negotiated amounts often exceed the cash price. Patients should verify their specific plan's deductible status before scheduling, as paying the full negotiated rate may be required if the deductible has not been met, whereas paying cash upfront could result in immediate cost avoidance.
To ensure you are not overcharged, it is recommended to request a detailed, itemized bill before paying any balance, as summary invoices can obscure individual line items and unbundled charges. Additionally, if you receive a bill for the difference between the provider's full charge and your insurance payment, you may be eligible for protections under the No Surprises Act, which bans balance billing for out-of-network services at in-network facilities. Finally, ask the billing department about prompt-pay discounts, which can reduce the total amount owed by 20% to 50% if settled in full within 30 days, effectively bypassing the administrative costs associated with insurance claims processing.