CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Mercy Hospital Carthage
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $81
- Cash Discount Price: $78
- vs. Medicare Baseline: 2.31x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mercy Hospital Carthage is $81. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.31x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.
Cash / Self-Pay
$78
Average discount available for prompt cash payment at this facility.
Insurance Median
$81
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: $78 (222%)
Insurance Median: $81 (231%)
Cash: $78 (222% of Medicare)
Ins. Median: $81 (231% 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 231% of the Medicare baseline (a markup of 131%). 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.
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 |
|---|---|---|
| Blue Cross Blue Shield | $28 - $185 | 80% |
| Medicaid / KanCare | $28 - $68 | 80% |
| Aetna | $32 - $110 | 91% |
| Cherokee Nation Health Serv Contracted [320066] | $32 - $34 | 91% |
| Cigna | $32 - $112 | 91% |
| Cross Timbers Hospice [20098] | $32 - $34 | 91% |
| Dept Of Veteran Affairs Contracted [320106] | $32 - $34 | 91% |
| Elara Caring Aspire Hospice [20433] | $32 - $34 | 91% |
| Globalhealth Contracted [320145] | $32 - $34 | 91% |
| Halo Hcr Inc Hospice Contracted [320432] | $32 - $34 | 91% |
| Halo Hcr Inc Hospice [20432] | $32 - $34 | 91% |
| Humana | $32 - $37 | 91% |
| Indian Health Service Contracted [320198] | $32 - $34 | 91% |
| Kindful Hospice Contracted [320434] | $32 - $34 | 91% |
| Kindful Hospice [20434] | $32 - $34 | 91% |
| Medical Associates Health Contracted [320444] | $32 - $34 | 91% |
| Medicare (plans) | $32 - $37 | 91% |
| Mercy Hospice Okc [20252] | $32 - $34 | 91% |
| Mercy Mgd Behavioral Health Contracted [320259] | $32 - $34 | 91% |
| Pace Of The Ozarks Contracted [320518] | $32 - $34 | 91% |
| Provider Partners Health Plans Contracted [320450] | $32 - $34 | 91% |
| Qual Choice Contracted [320325] | $32 - $34 | 91% |
| Tricare | $32 - $34 | 91% |
| UnitedHealthcare | $32 - $108 | 91% |
| Workers Comp [20426] | $40 - $112 | 114% |
| Point C Contracted [320238] | $41 - $112 | 117% |
| Health Systems Inc Contracted [320174] | $50 - $53 | 143% |
| Insurance System Inc Contracted [320465] | $50 - $53 | 143% |
| Administrative Payor Contracted [320005] | $53 - $56 | 151% |
| Centivo Contracted [320505] | $54 - $57 | 154% |
| Healthscope Contracted [320182] | $61 - $65 | 174% |
| Ambetter / Centene | $64 - $68 | 182% |
| Home State Health Plan Contracted [320187] | $64 - $68 | 182% |
| Novasys Contracted [320285] | $64 - $68 | 182% |
| Benefit Management Contracted [320052] | $70 - $108 | 200% |
| Auxiant Contracted [320462] | $76 - $105 | 217% |
| Healthlink Contracted [320179] | $76 - $115 | 217% |
| Preferred Health Plan Contracted [320522] | $76 - $81 | 217% |
| United Medical Resources Contracted [320454] | $97 - $112 | 277% |
| 90 Degree Benefits Contracted [320436] | $99 - $105 | 282% |
| Aither Health Contracted [320449] | $99 - $105 | 282% |
| Ebms Contracted [320493] | $99 - $105 | 282% |
| Edison Health Solutions Contracted [320502] | $99 - $105 | 282% |
| Imagine 360 Contracted [320494] | $99 - $105 | 282% |
| Mercy Benefit Admin Contracted [320251] | $99 - $112 | 282% |
| Reflect Health Contracted [320492] | $99 - $105 | 282% |
| Show-Me Health Administrators Contracted [320483] | $99 - $105 | 282% |
| Yuzu Health Contracted [320521] | $99 - $105 | 282% |
| Medica Contracted [320239] | $101 - $107 | 288% |
| Evolutions Health Care Contracted [320124] | $102 - $108 | 291% |
| First Health Contracted [320128] | $102 - $108 | 291% |
| Multiplan Contracted [320270] | $102 - $108 | 291% |
| Private Health Care Systems Contracted [320320] | $102 - $108 | 291% |
| American Healthcare Alliance Contracted [320020] | $105 - $112 | 299% |
| Ppo Plus Contracted [320310] | $105 - $112 | 299% |
| Usa Managed Care Org Contracted [320429] | $105 - $112 | 299% |