Occupational therapy (therapeutic activities)
Facility: Mercy Hospital St Louis
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $73
- Cash Discount Price: $95
- vs. Medicare Baseline: 2.08x 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 208% of the Medicare baseline (a markup of 108%). 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 |
|---|---|---|
| Aetna | $9 - $184 | 26% |
| Medicaid / KanCare | $9 - $145 | 26% |
| American Health Advantage Of Mo Mcr [10473] | $33 | 94% |
| Blue Cross Blue Shield | $33 - $298 | 94% |
| Cherokee Nation Health Serv Contracted [320066] | $33 | 94% |
| Cross Timbers Hospice [20098] | $33 | 94% |
| Dept Of Veteran Affairs Contracted [320106] | $33 | 94% |
| Elara Caring Aspire Hospice Contracted [320433] | $33 | 94% |
| Elara Caring Aspire Hospice [20433] | $33 | 94% |
| Globalhealth Contracted [320145] | $33 | 94% |
| Halo Hcr Inc Hospice Contracted [320432] | $33 | 94% |
| Halo Hcr Inc Hospice [20432] | $33 | 94% |
| Humana | $33 | 94% |
| Kindful Hospice Contracted [320434] | $33 | 94% |
| Kindful Hospice [20434] | $33 | 94% |
| Medicare (plans) | $33 - $146 | 94% |
| Mercy Hospice Okc [20252] | $33 | 94% |
| Pace Of The Ozarks Contracted [320518] | $33 | 94% |
| Qual Choice Contracted [320325] | $33 | 94% |
| Tricare | $33 | 94% |
| UnitedHealthcare | $33 - $193 | 94% |
| Cigna | $34 - $233 | 97% |
| Provider Partners Health Plans Contracted [320450] | $36 | 103% |
| Medica Contracted [320239] | $38 - $137 | 108% |
| Ambetter / Centene | $39 - $145 | 111% |
| Home State Health Plan Contracted [320187] | $39 - $145 | 111% |
| Novasys Contracted [320285] | $39 - $145 | 111% |
| Healthscope Contracted [320182] | $41 | 117% |
| Centivo Contracted [320505] | $56 | 160% |
| Preferred Health Plan Contracted [320522] | $59 | 168% |
| Aither Health Contracted [320449] | $63 - $215 | 180% |
| Aither Health [20449] | $63 - $215 | 180% |
| Auxiant Contracted [320462] | $63 - $215 | 180% |
| Ebms Contracted [320493] | $63 - $215 | 180% |
| Edison Health Solutions Contracted [320502] | $63 - $215 | 180% |
| Healthlink Contracted [320179] | $63 - $225 | 180% |
| Imagine 360 Contracted [320494] | $63 - $215 | 180% |
| Mercy Benefit Admin Contracted [320251] | $63 - $215 | 180% |
| Mercy Benefit Admin [20251] | $63 - $215 | 180% |
| Reflect Health Contracted [320492] | $63 - $215 | 180% |
| Show-Me Health Administrators Contracted [320483] | $63 - $219 | 180% |
| Yuzu Health Contracted [320521] | $63 - $215 | 180% |
| Hope Trust Contracted [320488] | $76 | 217% |
| Health Choices Contracted [320448] | $88 | 251% |
| Health Choices [20448] | $88 | 251% |
| Medical Associates Health Contracted [320444] | $88 | 251% |
| Federal Medical Center Contracted [320127] | $95 | 271% |
| Insurance System Inc Contracted [320465] | $95 | 271% |
| Point C Contracted [320238] | $95 | 271% |
| Tri State Healthcare Coalition Contracted [320379] | $95 | 271% |
| First Health Contracted [320128] | $102 - $104 | 291% |
| Mercy Mgd Behavioral Health Contracted [320259] | $102 | 291% |
| Multiplan Contracted [320270] | $102 - $110 | 291% |
| Private Health Care Systems Contracted [320320] | $102 | 291% |
| United Medical Resources Contracted [320454] | $107 - $193 | 305% |
| Workers Comp [20426] | $110 - $117 | 314% |