CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Carnegie Tri-County Municipal Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $85
Cash Discount Price: $68
vs. Medicare Baseline: 2.42x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Carnegie Tri-County Municipal Hospital is $85. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.42x the Medicare baseline. Located in 102 North Broadway, Carnegie, OK.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$85

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: $68 (194%)

Insurance Median: $85 (242%)

Cash: $68 (194% of Medicare)

Ins. Median: $85 (242% 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 242% of the Medicare baseline (a markup of 142%). 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	$25 - $163	71%
Blue Cross Blue Shield	$47 - $138	134%
Global Health Mcr Adv	$49 - $86	140%
Humana	$49 - $163	140%
UnitedHealthcare	$49 - $86	140%
Wellcare Mcr Adv - All Plans	$49 - $86	140%
Ambetter / Centene	$63 - $112	180%
Health Choice - All Plans	$64	182%
Community Care Comm Ip/Op Only - All Plans	$74 - $130	211%
Preferred Comm Ppo - All Plans	$74 - $130	211%
Global Health Ip/Op Only - All Other Plans	$78 - $138	222%
First Health - All Plans	$83 - $147	237%
Multiplan - All Plans	$85 - $150	242%
Soonerselect Mcaid - All Plans	$92 - $163	262%

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 $68.
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 Carnegie Tri-County Municipal 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.