CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Mercy Hospital Ada

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $94
Cash Discount Price: $108
vs. Medicare Baseline: 2.68x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mercy Hospital Ada is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $108. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.68x the Medicare baseline. Located in 430 North Monte Vista, Ada, OK.

Cash / Self-Pay

$108

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

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: $108 (308%)

Insurance Median: $94 (268%)

Cash: $108 (308% of Medicare)

Ins. Median: $94 (268% 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 268% of the Medicare baseline (a markup of 168%). 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	$32 - $133	91%
Humana	$32 - $34	91%
Medicaid / KanCare	$32 - $45	91%
Blue Cross Blue Shield	$33	94%
Cherokee Nation Health Serv Contracted [320066]	$33	94%
Cross Timbers Hospice [20098]	$33	94%
Dept Of Veteran Affairs Contracted [320106]	$33	94%
Elara Caring Aspire Hospice Contracted [320433]	$33	94%
Elara Caring Aspire Hospice [20433]	$33	94%
Halo Hcr Inc Hospice Contracted [320432]	$33	94%
Halo Hcr Inc Hospice [20432]	$33	94%
Independent Health [20197]	$33	94%
Indian Health Service Contracted [320198]	$33	94%
Kindful Hospice Contracted [320434]	$33	94%
Kindful Hospice [20434]	$33	94%
Medical Associates Health [20444]	$33	94%
Medicare (plans)	$33 - $177	94%
Mercy Hospice Okc [20252]	$33	94%
Provider Partners Health Plans Contracted [320450]	$33	94%
Qual Choice Contracted [320325]	$33	94%
Tricare	$33	94%
UnitedHealthcare	$33 - $124	94%
Cigna	$34	97%
Globalhealth Contracted [320145]	$34	97%
Workers Comp [20426]	$44	125%
Ambetter / Centene	$45	128%
Home State Health Plan Contracted [320187]	$45	128%
Novasys Contracted [320285]	$45	128%
Health Choice Contracted [320166]	$54	154%
Healthcare Highways Plus Contracted [320175]	$61 - $133	174%
Webtpa Contracted [320417]	$66 - $74	188%
Osma Health Contracted [320292]	$70 - $80	200%
Healthsmart Preferred Care Contracted [320184]	$74	211%
Kempton Contracted [320214]	$74	211%
Benefit Management Contracted [320052]	$78 - $115	222%
Aither Health Contracted [320449]	$94 - $106	268%
Auxiant Contracted [320462]	$94 - $106	268%
Ebms Contracted [320493]	$94 - $106	268%
Federal Medical Center Contracted [320127]	$94 - $106	268%
Healthlink Contracted [320179]	$94 - $106	268%
Healthscope Contracted [320182]	$94 - $106	268%
Imagine 360 Contracted [320494]	$94 - $106	268%
Mercy Benefit Admin Contracted [320251]	$94 - $115	268%
Point C Contracted [320238]	$94 - $106	268%
Preferred Health Plan Contracted [320522]	$94 - $106	268%
Quik Trip Contracted [320447]	$94 - $106	268%
Reflect Health Contracted [320492]	$94 - $106	268%
Show-Me Health Administrators Contracted [320483]	$94 - $106	268%
United Medical Resources Contracted [320454]	$94 - $124	268%
Yuzu Health Contracted [320521]	$94 - $106	268%
Medica Contracted [320239]	$95 - $177	271%
Globalhealth Contracted [320144]	$98 - $112	279%
First Health Contracted [320128]	$130 - $147	371%
Multiplan Contracted [320270]	$133 - $150	379%
Private Health Care Systems Contracted [320320]	$133 - $150	379%

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 $108.
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 Mercy Hospital Ada 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.