CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Southern Hills Hospital and Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $70
Cash Discount Price: $367
vs. Medicare Baseline: 2.00x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Southern Hills Hospital and Medical Center is $70. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $367. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.00x the Medicare baseline. Located in 9300 West Sunset Rd, Las Vegas, NV.

Cash / Self-Pay

$367

Average discount available for prompt cash payment at this facility.

Insurance Median

$70

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: $367 (1046%)

Insurance Median: $70 (200%)

Cash: $367 (1046% of Medicare)

Ins. Median: $70 (200% 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.

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	$5 - $70	14%
Humana	$30 - $35	86%
Alignment Health Plan	$31 - $35	88%
Ambetter / Centene	$31 - $78	88%
Blue Cross Blue Shield	$31 - $35	88%
Caremore	$31 - $36	88%
Community Care Health	$31	88%
Hometown Health Mcr	$31 - $35	88%
Molina Healthcare	$31 - $32	88%
Select Health	$31 - $86	88%
Sierra Hpn	$31	88%
Triwest	$31 - $35	88%
United	$31 - $81	88%
Caresource	$32	91%
Imperial Nv	$34 - $39	97%
Health Net	$35	100%
Universal Healthcare	$37 - $42	106%
Corvel	$65	185%
Olympus Medsave Usa	$68 - $280	194%
Prominence Healthfirst	$108 - $112	308%
Cmn Global	$151 - $157	431%
Evernorth	$180 - $186	513%
Hometown Health Providers	$180 - $186	513%
Nv Health & Welfare Trust	$216 - $224	616%
Multiplan	$227 - $272	647%
First Health	$238 - $298	679%
Medcare International	$270 - $280	770%

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 $367.
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 Southern Hills Hospital and Medical Center 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.