CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Mount Carmel New Albany Surgical Hospital
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $119
- Cash Discount Price: $165
- vs. Medicare Baseline: 3.39x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mount Carmel New Albany Surgical Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.39x the Medicare baseline. Located in 7333 Smith's Mill Road, New Albany, OH.
Cash / Self-Pay
$165
Average discount available for prompt cash payment at this facility.
Insurance Median
$119
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: $165 (470%)
Insurance Median: $119 (339%)
Cash: $165 (470% of Medicare)
Ins. Median: $119 (339% 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 339% of the Medicare baseline (a markup of 239%). 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 |
|---|---|---|
| Medicare (plans) | $29 - $35 | 83% |
| Aetna | $33 - $254 | 94% |
| Blue Cross Blue Shield | $33 - $254 | 94% |
| The Health Plan | $34 - $167 | 97% |
| Blue Benefit Administrators Of Massachusetts | $44 | 125% |
| Blue Care Network | $44 | 125% |
| Blue Distinction Transplant | $44 | 125% |
| Blue Shield - Ca | $44 | 125% |
| Blue Shield - Id (Regence) | $44 | 125% |
| Blue Shield - Ny Highmark Northeastern | $44 | 125% |
| Blue Shield - Ny Highmark Western | $44 | 125% |
| Blue Shield - Pa (Highmark) | $44 | 125% |
| Blue Shield - Wa (Regence) | $44 | 125% |
| Hospice Mount Carmel | $55 | 157% |
| Oscar | $55 | 157% |
| Medical Mutual | $61 - $202 | 174% |
| Enterprise Group Planning | $65 | 185% |
| Custom Design Benefits | $70 | 200% |
| Quality Care Partners | $76 | 217% |
| Western & Southern Financial Group | $88 | 251% |
| Rural Carrier Health Benefit Plan | $96 | 274% |
| Geha | $114 - $283 | 325% |
| Gravie Admin Services | $114 | 325% |
| Healthez | $114 | 325% |
| Meritain | $114 | 325% |
| Webtpa | $114 | 325% |
| Access Health | $119 | 339% |
| Acclaim | $119 | 339% |
| Administrative Concepts | $119 | 339% |
| Allegeant | $119 | 339% |
| Allied Benefit Systems | $119 | 339% |
| American Family | $119 | 339% |
| American Healthcare Alliance | $119 | 339% |
| American National | $119 | 339% |
| American Republic | $119 | 339% |
| Amerihealth | $119 | 339% |
| Aultcare | $119 | 339% |
| Automated Benefit Services | $119 | 339% |
| Auxiant | $119 | 339% |
| Benefit Administrative Systems,Llc | $119 | 339% |
| Boon Chapman | $119 | 339% |
| Cam Administrative Services | $119 | 339% |
| Christian Brother Services | $119 | 339% |
| Christian Brothers Holy Cross | $119 | 339% |
| Claimchoice Adminstrators | $119 | 339% |
| Comprehensive Benefits | $119 | 339% |
| Continental Life Insurance | $119 | 339% |
| Coventry | $119 | 339% |
| Custom Benefit Administrators | $119 | 339% |
| Cypress Benefit Administrators | $119 | 339% |
| Employee Benefit Concepts | $119 | 339% |
| Employee Benefit Management | $119 | 339% |
| Forest County Potawatomi | $119 | 339% |
| Freedom Life Insurance Company | $119 | 339% |
| Group Administrators | $119 | 339% |
| Group Marketing Services | $119 | 339% |
| Group Pension Administrators | $119 | 339% |
| Guardian | $119 | 339% |
| Health America | $119 | 339% |
| Health Choices | $119 | 339% |
| Healthcare Management Admin | $119 | 339% |
| Insight | $119 | 339% |
| Intercare | $119 | 339% |
| Jfp Benefit Management | $119 | 339% |
| Jp Farley Corporation | $119 | 339% |
| Key Benefit Administrator | $119 | 339% |
| Liberty Union Life Assurance Co | $119 | 339% |
| Lucent Health | $119 | 339% |
| Luminare Health | $119 | 339% |
| Magnacare | $119 | 339% |
| Medcost | $119 | 339% |
| Mutual Health Services | $119 | 339% |
| Mutual Of Omaha | $119 | 339% |
| Ncas | $119 | 339% |
| Nippon Life Ins | $119 | 339% |
| Nova | $119 | 339% |
| Painters Union Insurance Fund | $119 | 339% |
| Physicians Mutual | $119 | 339% |
| Plumbers Local 98 Insurance Fund | $119 | 339% |
| Prairie States | $119 | 339% |
| Preferred One | $119 | 339% |
| Primary Physician Care | $119 | 339% |
| Professional Benefit Administrators | $119 | 339% |
| Secureone Preferred United Plans | $119 | 339% |
| Siho Insurance Services | $119 | 339% |
| Sisco Benefits | $119 | 339% |
| The Loomis Company | $119 | 339% |
| Trustmark Small Business Benefits | $119 | 339% |
| U Of M Health Plan | $119 | 339% |
| Unicare | $119 | 339% |
| Unified Group Services | $119 | 339% |
| Us Health And Life | $119 | 339% |
| Valenz | $119 | 339% |
| Varipro | $119 | 339% |
| Wps | $119 | 339% |
| Humana | $130 - $254 | 371% |
| First Health | $134 | 382% |
| Medben | $152 - $190 | 433% |
| Consociate | $155 | 442% |
| Health Ohio Network | $155 | 442% |
| UnitedHealthcare | $172 - $283 | 490% |
| Caresource | $185 | 528% |
| Healthlink Inc | $190 | 542% |
| Medical Benefits Mutual | $190 | 542% |
| Ohio Health Choice | $190 | 542% |
| Ohio Ppo Connect | $190 | 542% |
| Ameriben | $203 | 579% |
| Luminare Health (Detroit) | $203 | 579% |
| Medi Share | $203 | 579% |
| Multiplan | $203 | 579% |
| Ohiohealthy | $203 | 579% |
| Osu Not Independent Choice | $203 | 579% |
| Phcs | $203 | 579% |
| Philadelphia American Life Insurance | $203 | 579% |
| Twin Valley Psychiatric | $203 | 579% |
| Health Smart | $216 | 616% |
| American Postal Workers Secondary | $232 | 662% |
| Cigna | $232 | 662% |
| Health Partners | $232 | 662% |
| Healthgram | $232 | 662% |
| Mvp | $232 | 662% |
| Priority Health | $232 | 662% |
| Bccp | $254 | 724% |
| Medicaid / KanCare | $254 | 724% |
| Optima Health | $254 | 724% |
| Crime Victim Assistance | $632 | 1802% |
| Ohio Safe Program | $632 | 1802% |