CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Mercy Hospital Tishomingo Inc
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $65
- Cash Discount Price: $86
- vs. Medicare Baseline: 1.85x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mercy Hospital Tishomingo Inc is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.85x the Medicare baseline. Located in 1000 South Byrd St, Tishomingo, OK.
Cash / Self-Pay
$86
Average discount available for prompt cash payment at this facility.
Insurance Median
$65
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: $86 (245%)
Insurance Median: $65 (185%)
Cash: $86 (245% of Medicare)
Ins. Median: $65 (185% 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.
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 - $88 | 91% |
| Humana | $32 - $106 | 91% |
| Medicaid / KanCare | $32 - $40 | 91% |
| Ambetter / Centene | $40 | 114% |
| Home State Health Plan Contracted [320187] | $40 | 114% |
| Novasys Contracted [320285] | $40 | 114% |
| Blue Cross Blue Shield | $42 - $63 | 120% |
| Health Choice Contracted [320166] | $54 | 154% |
| Webtpa Contracted [320417] | $55 | 157% |
| Medicare (plans) | $61 - $84 | 174% |
| Cherokee Nation Health Serv Contracted [320066] | $63 | 180% |
| Cross Timbers Hospice [20098] | $63 | 180% |
| Dept Of Veteran Affairs Contracted [320106] | $63 | 180% |
| Elara Caring Aspire Hospice Contracted [320433] | $63 | 180% |
| Elara Caring Aspire Hospice [20433] | $63 | 180% |
| Halo Hcr Inc Hospice Contracted [320432] | $63 | 180% |
| Halo Hcr Inc Hospice [20432] | $63 | 180% |
| Independent Health [20197] | $63 | 180% |
| Indian Health Service Contracted [320198] | $63 | 180% |
| Kindful Hospice Contracted [320434] | $63 | 180% |
| Kindful Hospice [20434] | $63 | 180% |
| Medical Associates Health [20444] | $63 | 180% |
| Mercy Hospice Okc [20252] | $63 | 180% |
| Provider Partners Health Plans Contracted [320450] | $63 | 180% |
| Qual Choice Contracted [320325] | $63 | 180% |
| Tribute Health Plan Mcr Contracted [320338] | $63 | 180% |
| Tricare | $63 | 180% |
| UnitedHealthcare | $63 - $104 | 180% |
| Cigna | $65 - $99 | 185% |
| Globalhealth Contracted [320145] | $65 | 185% |
| Aither Health Contracted [320449] | $79 - $112 | 225% |
| Mercy Benefit Admin Contracted [320251] | $79 - $112 | 225% |
| Quik Trip Contracted [320447] | $79 | 225% |
| Show-Me Health Administrators Contracted [320483] | $79 | 225% |
| Medica Contracted [320239] | $84 | 240% |
| First Health Contracted [320128] | $88 | 251% |
| Osma Health Contracted [320292] | $92 | 262% |
| Benefit Management Contracted [320052] | $99 - $119 | 282% |
| Healthcare Highways Plus Contracted [320175] | $99 | 282% |
| Private Health Care Systems Contracted [320320] | $99 - $106 | 282% |
| United Medical Resources Contracted [320454] | $104 | 297% |
| Multiplan Contracted [320270] | $106 - $119 | 302% |
| Auxiant Contracted [320462] | $112 | 319% |
| Ebms Contracted [320493] | $112 | 319% |
| Healthlink Contracted [320179] | $112 | 319% |
| Imagine 360 Contracted [320494] | $112 | 319% |
| Preferred Community Choice Contracted [320311] | $112 | 319% |
| Reflect Health Contracted [320492] | $112 | 319% |
| Yuzu Health Contracted [320521] | $112 | 319% |