CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: St Mary Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $66
Cash Discount Price: $127
vs. Medicare Baseline: 1.88x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at St Mary Medical Center is $66. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $127. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.88x the Medicare baseline. Located in Langhorne-Newtown Rd, Langhorne, PA.

Cash / Self-Pay

$127

Average discount available for prompt cash payment at this facility.

Insurance Median

$66

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: $127 (362%)

Insurance Median: $66 (188%)

Cash: $127 (362% of Medicare)

Ins. Median: $66 (188% 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
Medicaid / KanCare	$15 - $31	43%
Aetna	$19 - $174	54%
UnitedHealthcare	$21 - $103	60%
Pace-Trinity Health	$25	71%
Keystone First	$31	88%
Keystone First Chip	$31	88%
Blue Cross Blue Shield	$36 - $70	103%
Align Senior Care	$37	106%
Cigna	$37 - $358	106%
Medicare (plans)	$37 - $66	106%
Health America Advantra	$44	125%
Ambetter / Centene	$65	185%
Jefferson Health Plan Commercial	$66	188%
Oscar	$66	188%
Prime Healthcare	$66	188%
Amerihealth	$70	200%
Blue Shield - Ca	$70	200%
Blue Shield - Id (Regence)	$70	200%
Blue Shield - Ny Highmark Western	$70	200%
Blue Shield - Wa (Regence)	$70	200%
Homestead Health Plans Woods Center	$71	202%
Group Pension Administrators	$82	234%
Reedman Toll	$82	234%
Blue Shield - Pa (Highmark)	$98	279%
Geha	$103	294%
Meritain	$174	496%
Multiplan	$176	502%
Prime Health Services	$176	502%
Galaxy Health Network	$185	528%
Three Rivers Provider Network	$185	528%
Upmc Health Plan	$358	1021%
Webtpa	$358	1021%

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 $127.
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 St Mary 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.