CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Ste Genevieve County Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $122
Cash Discount Price: $152
vs. Medicare Baseline: 3.48x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Ste Genevieve County Memorial Hospital is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.48x the Medicare baseline. Located in Hwys 61 & 32, Sainte Genevieve, MO.

Cash / Self-Pay

$152

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

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: $152 (433%)

Insurance Median: $122 (348%)

Cash: $152 (433% of Medicare)

Ins. Median: $122 (348% 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 348% of the Medicare baseline (a markup of 248%). 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
Aetna	$26 - $380	74%
Allwell	$26 - $126	74%
Blue Cross Blue Shield	$26 - $164	74%
Medicare (plans)	$26 - $124	74%
Va	$26 - $124	74%
Pphp	$30 - $142	86%
Ambetter / Centene	$32 - $154	91%
Healthy_Blue	$42 - $202	120%
Medicaid / KanCare	$42 - $202	120%
Uhc_Community	$42 - $202	120%
Homestate	$43 - $206	123%
UnitedHealthcare	$62 - $452	177%
Meritain	$79 - $380	225%
Multiplan/Phcs	$88 - $420	251%
Healthlink_Compmanagement	$92 - $440	262%
Healthlink_Hmo	$92 - $440	262%
Healthlink_Ppo	$92 - $440	262%
Cigna	$102 - $405	291%

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 $152.
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 Ste Genevieve County Memorial Hospital 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.