CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Mercy Hospital Washington

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $102
Cash Discount Price: $94
vs. Medicare Baseline: 2.91x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mercy Hospital Washington is $102. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $94. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.91x the Medicare baseline. Located in 901 East 5Th Street, Washington, MO.

Cash / Self-Pay

$94

Average discount available for prompt cash payment at this facility.

Insurance Median

$102

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: $94 (268%)

Insurance Median: $102 (291%)

Cash: $94 (268% of Medicare)

Ins. Median: $102 (291% 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 291% of the Medicare baseline (a markup of 191%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

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	$9 - $145	26%
Aetna	$22 - $184	63%
American Health Advantage Of Mo Mcr [10473]	$31	88%
Blue Cross Blue Shield	$31 - $274	88%
Cherokee Nation Health Serv Contracted [320066]	$31	88%
Cross Timbers Hospice [20098]	$31	88%
Dept Of Veteran Affairs Contracted [320106]	$31	88%
Elara Caring Aspire Hospice Contracted [320433]	$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%
Humana	$31	88%
Kindful Hospice Contracted [320434]	$31	88%
Kindful Hospice [20434]	$31	88%
Medicare (plans)	$31 - $145	88%
Mercy Hospice Okc [20252]	$31	88%
Pace Of The Ozarks Contracted [320518]	$31	88%
Qual Choice Contracted [320325]	$31	88%
Tricare	$31	88%
UnitedHealthcare	$31 - $193	88%
Cigna	$34 - $198	97%
Provider Partners Health Plans Contracted [320450]	$34	97%
Healthscope Contracted [320182]	$39	111%
Centivo Contracted [320505]	$52	148%
Preferred Health Plan Contracted [320522]	$56	160%
Hope Trust Contracted [320488]	$76	217%
Health Choices Contracted [320448]	$86 - $87	245%
Health Choices [20448]	$86 - $87	245%
Medical Associates Health Contracted [320444]	$86 - $87	245%
Federal Medical Center Contracted [320127]	$94	268%
Insurance System Inc Contracted [320465]	$94	268%
Point C Contracted [320238]	$94	268%
Tri State Healthcare Coalition Contracted [320379]	$94	268%
Healthlink Contracted [320179]	$98 - $225	279%
First Health Contracted [320128]	$101 - $103	288%
Mercy Mgd Behavioral Health Contracted [320259]	$101 - $102	288%
Multiplan Contracted [320270]	$101 - $109	288%
Private Health Care Systems Contracted [320320]	$101 - $102	288%
Workers Comp [20426]	$108 - $116	308%
Medica Contracted [320239]	$137	391%
Ambetter / Centene	$145	413%
Home State Health Plan Contracted [320187]	$145	413%
Novasys Contracted [320285]	$145	413%
Mercy Benefit Admin Contracted [320251]	$170 - $209	485%
Mercy Benefit Admin [20251]	$170 - $209	485%
United Medical Resources Contracted [320454]	$193	550%
Show-Me Health Administrators Contracted [320483]	$203 - $213	579%
Aither Health Contracted [320449]	$209	596%
Aither Health [20449]	$209	596%
Auxiant Contracted [320462]	$209	596%
Ebms Contracted [320493]	$209	596%
Edison Health Solutions Contracted [320502]	$209	596%
Imagine 360 Contracted [320494]	$209	596%
Reflect Health Contracted [320492]	$209	596%
Yuzu Health Contracted [320521]	$209	596%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $94.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Mercy Hospital Washington is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.