CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: St Louis Childrens Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $107
Cash Discount Price: $90
vs. Medicare Baseline: 3.05x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at St Louis Childrens Hospital is $107. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.05x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$107

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: $90 (257%)

Insurance Median: $107 (305%)

Cash: $90 (257% of Medicare)

Ins. Median: $107 (305% 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 305% of the Medicare baseline (a markup of 205%). 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	$34 - $118	97%
Blue Cross Blue Shield	$34 - $128	97%
Essence Healthcare [221]	$34	97%
Humana	$34 - $112	97%
UnitedHealthcare	$34 - $111	97%
Cox Health [757]	$35	100%
Medica [662]	$35	100%
Healthlink [225]	$73 - $113	208%
Cigna	$74 - $81	211%
Apwu Health Plan [216]	$81	231%
Consociate [478]	$81	231%
Nalc Health Benefit Plan [242]	$81	231%
Priority Health [648]	$81	231%
Sarah Bush Lincoln [636]	$81	231%
Cox Health Systems Insurance Company [220]	$82 - $111	234%
Allied Benefits [498]	$87 - $118	248%
Hope Trust [806]	$87	248%
Med-Pay [480]	$98 - $112	279%
Unicare [568]	$98 - $113	279%
Health Alliance [224]	$105	299%
Healthscope Benefits [258]	$107 - $120	305%
First Health Commercial [734]	$111	317%
Beechstreet [551]	$112	319%
Detego Health [868]	$112	319%
Health Systems Inc [620]	$112	319%
Healthcare Sol Mercy [609]	$112	319%
Multiplan Commercial [737]	$112	319%
Multiplan [240]	$112	319%
Phcs [244]	$112 - $120	319%
Preferred Health Professionals [561]	$113	322%
Coresource [497]	$118	336%
Fmh Benefit Service Inc [222]	$118	336%
Mail Handlers [495]	$118	336%
Medica [661]	$120	342%
Hfn [563]	$128	365%

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 $90.
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 St Louis Childrens 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.