CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Blount Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $111
Cash Discount Price: $52
vs. Medicare Baseline: 3.17x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Blount Memorial Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.17x the Medicare baseline. Located in 907 E Lamar Alexander Parkway, Maryville, TN.

Cash / Self-Pay

$52

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $52 (148%)

Insurance Median: $111 (317%)

Cash: $52 (148% of Medicare)

Ins. Median: $111 (317% 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 317% of the Medicare baseline (a markup of 217%). 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
Medicaid / KanCare	$23 - $33	66%
UnitedHealthcare	$23 - $190	66%
Blue Cross Blue Shield	$33 - $140	94%
Humana	$33	94%
Medicare (plans)	$33 - $34	94%
Cigna	$34 - $186	97%
Prisma Health Seniorcare Pace - Midlands [5400]	$35 - $43	100%
Prisma Health Seniorcare Pace-Upstate [5200]	$35 - $43	100%
Tricare	$35	100%
Ambetter / Centene	$51	145%
Promise Health Plan Contracted [2401]	$52 - $112	148%
Orangeburg Senior Helping Center Pace [5401]	$60 - $74	171%
Consociate Health Contracted [4835]	$73	208%
Bob Jones Univ-Pai [821]	$90 - $112	257%
Preferred Administrators Contracted [2839]	$105 - $130	299%
Medcost [2940]	$111 - $154	317%
Atlantic Packaging Contracted [4833]	$112 - $140	319%
Aps Healthcare System [2981]	$120 - $149	342%
Multiplan/Phcs Contracted [2950]	$134 - $166	382%
Aetna	$135 - $167	385%
Meritain Health Contracted [2200]	$135 - $167	385%
Nippon [2300]	$135 - $167	385%
Vsp Vision Care [2986]	$135 - $167	385%
First Health Contracted [2952]	$140 - $173	399%
Furman Int/Allen University Student [2951]	$140 - $173	399%
Quiktrip-First Health [3067]	$140 - $173	399%
Fairos/Occunet Contracted [4837]	$175	499%
Mvp Health Care [3037]	$186	530%
Golden Rule Insurance Company [2991]	$190	542%
Oxford Health Plans [2992]	$190	542%

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 $52.
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 Blount Memorial 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.