CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Mercy Hospital Joplin
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $95
- Cash Discount Price: $109
- vs. Medicare Baseline: 2.71x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mercy Hospital Joplin is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $109. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.71x the Medicare baseline. Located in 100 Mercy Way, Joplin, MO.
Cash / Self-Pay
$109
Average discount available for prompt cash payment at this facility.
Insurance Median
$95
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: $109 (311%)
Insurance Median: $95 (271%)
Cash: $109 (311% of Medicare)
Ins. Median: $95 (271% 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 271% of the Medicare baseline (a markup of 171%). 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 |
|---|---|---|
| Medicaid / KanCare | $22 - $55 | 63% |
| Blue Cross Blue Shield | $28 - $197 | 80% |
| Humana | $30 - $51 | 86% |
| Aetna | $31 - $55 | 88% |
| Centivo Contracted [320505] | $31 | 88% |
| Champva [20065] | $31 | 88% |
| Cherokee Nation Health Serv Contracted [320066] | $31 | 88% |
| Cigna | $31 - $131 | 88% |
| Cross Timbers Hospice [20098] | $31 | 88% |
| Dept Of Veteran Affairs Contracted [320106] | $31 | 88% |
| Elara Caring Aspire Hospice [20433] | $31 | 88% |
| Globalhealth Contracted [320145] | $31 | 88% |
| Halo Hcr Inc Hospice Contracted [320432] | $31 | 88% |
| Halo Hcr Inc Hospice [20432] | $31 | 88% |
| Indian Health Service Contracted [320198] | $31 - $110 | 88% |
| Kindful Hospice Contracted [320434] | $31 | 88% |
| Kindful Hospice [20434] | $31 | 88% |
| Medicare (plans) | $31 - $34 | 88% |
| Mercy Hospice Okc [20252] | $31 | 88% |
| Mercy Mgd Behavioral Health Contracted [320259] | $31 | 88% |
| Pace Of The Ozarks Contracted [320518] | $31 | 88% |
| Provider Partners Health Plans Contracted [320450] | $31 | 88% |
| Qual Choice Contracted [320325] | $31 | 88% |
| Tricare | $31 | 88% |
| UnitedHealthcare | $31 - $70 | 88% |
| Healthscope Contracted [320182] | $39 | 111% |
| Workers Comp [20426] | $40 - $144 | 114% |
| Ambetter / Centene | $46 - $48 | 131% |
| Home State Health Plan Contracted [320187] | $46 - $48 | 131% |
| Novasys Contracted [320285] | $46 - $48 | 131% |
| Health Choice Contracted [320166] | $49 | 140% |
| Point C Contracted [320238] | $58 - $136 | 165% |
| Medica Contracted [320239] | $60 - $62 | 171% |
| Providrs Care Network Contracted [320484] | $62 | 177% |
| United Medical Resources Contracted [320454] | $68 - $77 | 194% |
| Benefit Management Contracted [320052] | $71 - $73 | 202% |
| Health Systems Inc Contracted [320174] | $71 - $73 | 202% |
| Insurance System Inc Contracted [320465] | $71 - $73 | 202% |
| Administrative Payor Contracted [320005] | $75 - $76 | 214% |
| Mercy Benefit Admin Contracted [320251] | $83 - $195 | 237% |
| Aither Health Contracted [320449] | $95 - $97 | 271% |
| Auxiant Contracted [320462] | $95 - $110 | 271% |
| Ebms Contracted [320493] | $95 - $97 | 271% |
| Edison Health Solutions Contracted [320502] | $95 - $97 | 271% |
| Healthlink Contracted [320179] | $95 - $136 | 271% |
| Imagine 360 Contracted [320494] | $95 - $97 | 271% |
| Reflect Health Contracted [320492] | $95 - $97 | 271% |
| Yuzu Health Contracted [320521] | $95 - $97 | 271% |
| 90 Degree Benefits Contracted [320436] | $100 - $195 | 285% |
| Show-Me Health Administrators Contracted [320483] | $100 - $195 | 285% |
| Preferred Health Plan Contracted [320522] | $108 - $110 | 308% |
| First Health Contracted [320128] | $113 - $116 | 322% |
| American Healthcare Alliance Contracted [320020] | $116 - $119 | 331% |
| Multiplan Contracted [320270] | $128 - $131 | 365% |
| Private Health Care Systems Contracted [320320] | $128 - $131 | 365% |
| Usable Contracted [320409] | $128 - $131 | 365% |
| Point C [20238] | $133 - $136 | 379% |
| Usa Managed Care Org Contracted [320429] | $146 - $150 | 416% |
| Ppo Plus Contracted [320310] | $149 - $153 | 425% |