Occupational therapy (therapeutic activities)
Facility: Children'S Mercy South
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $80
- Cash Discount Price: $74
- vs. Medicare Baseline: 2.28x 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 228% of the Medicare baseline (a markup of 128%). 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 |
|---|---|---|
| Cigna | $14 - $116 | 40% |
| UnitedHealthcare | $27 - $112 | 77% |
| Healthy Blue | $29 - $96 | 83% |
| Medicaid / KanCare | $29 - $33 | 83% |
| Home State Health | $39 - $84 | 111% |
| Quiktrip | $40 - $109 | 114% |
| Blue Cross Blue Shield | $40 - $124 | 114% |
| Wppa Providrs Care | $43 - $109 | 123% |
| Healthlink | $47 - $147 | 134% |
| Health Midwest Comprehensive Care | $49 - $109 | 140% |
| American Healthcare Alliance | $51 - $142 | 145% |
| Aetna | $51 - $114 | 145% |
| Multiplan | $52 - $127 | 148% |
| Humana | $62 - $111 | 177% |
| Orscheln | $63 - $109 | 180% |
| Coventry Health Care Of Kansas | $65 - $124 | 185% |
| Wellfit/Centrus | $68 - $109 | 194% |
| Centivo | $70 - $109 | 200% |
| Nebraska Furniture Mart | $73 - $109 | 208% |
| Medica | $82 - $97 | 234% |
| Mercy Health | $103 - $125 | 294% |
| Coxhealth Network | $104 - $124 | 297% |
| National Preferred Provider Network | $124 - $150 | 354% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service at Children's Mercy South in Overland Park, Kansas, the cash price is $74.00, which is significantly lower than the facility's negotiated rates with insurance carriers. While the facility's cash rate is well below the state average of $80.00, patients should be aware that insurance plans often pay negotiated amounts ranging from $14 to $150 depending on the specific carrier. For individuals with high-deductible plans, paying the cash price of $74.00 upfront may result in immediate savings compared to the higher negotiated rates that commercial payers charge, as these insurance rates frequently exceed the cash price to cover administrative processing costs.
To ensure you are receiving the most accurate and fair pricing, it is essential to request an itemized bill before finalizing payment. Hospitals often issue summary bills that obscure individual charges, but an itemized statement allows you to verify that no unbundled codes or services not rendered have been included. Additionally, patients should explicitly ask about "prompt-pay" discounts, which can reduce the cash price by 20% to 50% if paid in full within a short window, effectively bypassing the administrative overhead associated with insurance billing. Always confirm your deductible status and request a self-pay classification prior to scheduling to avoid unexpected balance billing or automatic claim submissions that could void potential cash discounts.