CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Mercy Health Lakeshore Campus
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $107
- Cash Discount Price: $81
- vs. Medicare Baseline: 3.05x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mercy Health Lakeshore Campus is $107. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $81. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.05x the Medicare baseline. Located in 72 South State Street, Shelby, MI.
Cash / Self-Pay
$81
Average discount available for prompt cash payment at this facility.
Insurance Median
$107
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: $81 (231%)
Insurance Median: $107 (305%)
Cash: $81 (231% of Medicare)
Ins. Median: $107 (305% 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 305% of the Medicare baseline (a markup of 205%). 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.
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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 |
|---|---|---|
| Access Health | $22 | 63% |
| Blue Cross Blue Shield | $25 - $106 | 71% |
| Medicaid / KanCare | $25 | 71% |
| Blue Care Network Advantage | $30 | 86% |
| Medicare (plans) | $30 | 86% |
| Aetna | $31 - $99 | 88% |
| Oscar | $38 | 108% |
| UnitedHealthcare | $43 - $112 | 123% |
| Molina Marketplace | $52 | 148% |
| Wellpath | $52 | 148% |
| U Of M Health Plan | $53 - $111 | 151% |
| Hospice Of Michigan | $68 | 194% |
| Nomi Health | $69 | 197% |
| Hap | $93 - $114 | 265% |
| Wc Accident Fund | $98 | 279% |
| Wc Advantage | $98 | 279% |
| Wc Aig | $98 | 279% |
| Wc Allied | $98 | 279% |
| Wc Amerisure | $98 | 279% |
| Wc Amtrust | $98 | 279% |
| Wc Asu Risk Mgt | $98 | 279% |
| Wc Berkley Admin | $98 | 279% |
| Wc Broadspire | $98 | 279% |
| Wc Bunch & Associates | $98 | 279% |
| Wc Ccmsi | $98 | 279% |
| Wc Emc Insurance Company | $98 | 279% |
| Wc Esis | $98 | 279% |
| Wc Fcci | $98 | 279% |
| Wc Federated | $98 | 279% |
| Wc Gallagher Bassett | $98 | 279% |
| Wc Genex Care For Ohio | $98 | 279% |
| Wc Guard Insurance Company | $98 | 279% |
| Wc Hartford | $98 | 279% |
| Wc Liberty Mutual | $98 | 279% |
| Wc Meijers | $98 | 279% |
| Wc Michigan | $98 | 279% |
| Wc Mitchell Frankenmuth | $98 | 279% |
| Wc Pma | $98 | 279% |
| Wc Sedgwick | $98 | 279% |
| Wc Sentry | $98 | 279% |
| Wc Travelers | $98 | 279% |
| Wc Tristar | $98 | 279% |
| Wc Walmart | $98 | 279% |
| Wc Zurich | $98 | 279% |
| Geha | $99 - $112 | 282% |
| Meritain | $99 | 282% |
| Asr Health Benefits | $103 | 294% |
| Bcn Domestic | $106 | 302% |
| Blue Benefit Administrators Of Massachusetts | $106 | 302% |
| Blue Care Network | $106 | 302% |
| Blue Distinction Transplant | $106 | 302% |
| Blue Shield - Ca | $106 | 302% |
| Blue Shield - Id (Regence) | $106 | 302% |
| Blue Shield - Ny Highmark Northeastern | $106 | 302% |
| Blue Shield - Ny Highmark Western | $106 | 302% |
| Blue Shield - Pa (Highmark) | $106 | 302% |
| Blue Shield - Wa (Regence) | $106 | 302% |
| Health Choices | $106 - $111 | 302% |
| Kaiser Domestic | $106 | 302% |
| 1199 National Benefit Fund | $107 | 305% |
| Allied National Global Care | $107 | 305% |
| Asrm - Reliance Standard Life Insurance | $107 | 305% |
| Christian Care Ministry | $107 | 305% |
| Dean Health | $107 | 305% |
| Fallon Health | $107 | 305% |
| Family Life Insurance Company | $107 | 305% |
| Ghc Scw | $107 | 305% |
| Group Pension Administrators | $107 | 305% |
| International Benefit Administrators | $107 | 305% |
| Lifetime Benefit Solutions | $107 | 305% |
| Manhattan Life | $107 | 305% |
| Medi Share | $107 | 305% |
| Multiplan | $107 | 305% |
| Mvp | $107 | 305% |
| Pai | $107 | 305% |
| Pan-American Life | $107 | 305% |
| Paramount Hmo | $107 | 305% |
| Phcs | $107 | 305% |
| Trinity Health Share | $107 | 305% |
| Cigna | $108 | 308% |
| Acclaim | $111 | 317% |
| Administrative Concepts | $111 | 317% |
| Allegeant | $111 | 317% |
| Allied Benefit Systems | $111 | 317% |
| Ameriben | $111 | 317% |
| American Family | $111 | 317% |
| American Healthcare Alliance | $111 | 317% |
| American Republic | $111 | 317% |
| Amerihealth | $111 | 317% |
| Aultcare | $111 | 317% |
| Automated Benefit Services | $111 | 317% |
| Auxiant | $111 | 317% |
| Benefit Administrative Systems,Llc | $111 | 317% |
| Boon Chapman | $111 | 317% |
| Cam Administrative Services | $111 | 317% |
| Caresource | $111 | 317% |
| Christian Brother Services | $111 | 317% |
| Christian Brothers Holy Cross | $111 | 317% |
| Claimchoice Adminstrators | $111 | 317% |
| Comprehensive Benefits | $111 | 317% |
| Consociate | $111 | 317% |
| Continental Life Insurance | $111 | 317% |
| Custom Benefit Administrators | $111 | 317% |
| Cypress Benefit Administrators | $111 | 317% |
| Employee Benefit Concepts | $111 | 317% |
| Employee Benefit Management | $111 | 317% |
| Enterprise Group Planning | $111 | 317% |
| Forest County Potawatomi | $111 | 317% |
| Freedom Life Insurance Company | $111 | 317% |
| Group Administrators | $111 | 317% |
| Group Marketing Services | $111 | 317% |
| Guardian | $111 | 317% |
| Health America | $111 | 317% |
| Health Smart | $111 | 317% |
| Healthez | $111 | 317% |
| Healthgram | $111 | 317% |
| Healthscope | $111 | 317% |
| Humana | $111 | 317% |
| Insight | $111 | 317% |
| Intercare | $111 | 317% |
| Jfp Benefit Management | $111 | 317% |
| Jp Farley Corporation | $111 | 317% |
| Key Benefit Administrator | $111 | 317% |
| Liberty Union Life Assurance Co | $111 | 317% |
| Lucent Health | $111 | 317% |
| Luminare Health | $111 | 317% |
| Luminare Health (Detroit) | $111 | 317% |
| Medben | $111 | 317% |
| Medcost | $111 | 317% |
| Medical Mutual | $111 | 317% |
| Mutual Health Services | $111 | 317% |
| Mutual Of Omaha | $111 | 317% |
| Ncas | $111 | 317% |
| Nippon Life Ins | $111 | 317% |
| Nova | $111 | 317% |
| Painters Union Insurance Fund | $111 | 317% |
| Physicians Mutual | $111 | 317% |
| Plumbers Local 98 Insurance Fund | $111 | 317% |
| Prairie States | $111 | 317% |
| Primary Physician Care | $111 | 317% |
| Professional Benefit Administrators | $111 | 317% |
| Secureone Preferred United Plans | $111 | 317% |
| The Loomis Company | $111 | 317% |
| Trustmark Small Business Benefits | $111 | 317% |
| Unicare | $111 | 317% |
| Unified Group Services | $111 | 317% |
| Us Health And Life | $111 | 317% |
| Valenz | $111 | 317% |
| Varipro | $111 - $114 | 317% |
| Western & Southern Financial Group | $111 | 317% |
| Wps | $111 | 317% |
| First Health | $112 | 319% |
| Priority Health | $112 | 319% |