Occupational therapy (therapeutic activities)
Facility: Mercy St Francis Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $114
- Cash Discount Price: $83
- vs. Medicare Baseline: 3.25x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 325% of the Medicare baseline (a markup of 225%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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 | $28 - $66 | 80% |
| Blue Cross Blue Shield | $33 - $123 | 94% |
| Medicare (plans) | $33 - $45 | 94% |
| Globalhealth Contracted [320145] | $35 - $44 | 100% |
| Qual Choice Contracted [320325] | $35 - $44 | 100% |
| Halo Hcr Inc Hospice Contracted [320432] | $35 - $44 | 100% |
| Indian Health Service Contracted [320198] | $35 - $44 | 100% |
| Medical Associates Health Contracted [320444] | $35 - $44 | 100% |
| Halo Hcr Inc Hospice [20432] | $35 - $44 | 100% |
| Provider Partners Health Plans Contracted [320450] | $35 - $44 | 100% |
| Mercy Mgd Behavioral Health Contracted [320259] | $35 - $44 | 100% |
| Elara Caring Aspire Hospice [20433] | $35 - $44 | 100% |
| Kindful Hospice [20434] | $35 - $44 | 100% |
| Dept of Veteran Affairs Contracted [320106] | $35 - $44 | 100% |
| Pace of the Ozarks Contracted [320518] | $35 - $44 | 100% |
| Cigna | $35 - $121 | 100% |
| Humana | $35 - $114 | 100% |
| UnitedHealthcare | $35 - $121 | 100% |
| Aetna | $35 - $113 | 100% |
| Mercy Hospice Okc [20252] | $35 - $44 | 100% |
| Cross Timbers Hospice [20098] | $35 - $44 | 100% |
| Cherokee Nation Health Serv Contracted [320066] | $35 - $44 | 100% |
| Acentra Health Contracted [320527] | $35 | 100% |
| Kindful Hospice Contracted [320434] | $35 - $44 | 100% |
| Tricare | $43 | 123% |
| Healthscope Contracted [320182] | $44 - $58 | 125% |
| Administrative Payor Contracted [320005] | $57 | 163% |
| Centivo Contracted [320505] | $58 - $74 | 165% |
| Home State Health Plan Contracted [320187] | $66 | 188% |
| Novasys Contracted [320285] | $66 | 188% |
| Ambetter / Centene | $66 | 188% |
| Preferred Health Plan Contracted [320522] | $83 | 237% |
| Healthlink Contracted [320179] | $83 - $121 | 237% |
| Workers Comp [20426] | $102 - $108 | 291% |
| Auxiant Contracted [320462] | $114 - $121 | 325% |
| United Medical Resources Contracted [320454] | $114 - $118 | 325% |
| Mercy Benefit Admin Contracted [320251] | $114 - $121 | 325% |
| Point C Contracted [320238] | $114 - $121 | 325% |
| Medica Contracted [320239] | $120 | 342% |
| Private Health Care Systems Contracted [320320] | $121 | 345% |
| Multiplan Contracted [320270] | $121 | 345% |
| Health Systems Inc Contracted [320174] | $121 | 345% |
| Edison Health Solutions Contracted [320502] | $121 | 345% |
| First Health Contracted [320128] | $121 | 345% |
| USA Managed Care Org Contracted [320429] | $121 | 345% |
| Ebms Contracted [320493] | $121 | 345% |
| Insurance System Inc Contracted [320465] | $121 | 345% |
| Yuzu Health Contracted [320521] | $121 | 345% |
| Reflect Health Contracted [320492] | $121 | 345% |
| Benefit Management Contracted [320052] | $121 | 345% |
| Show-Me Health Administrators Contracted [320483] | $121 | 345% |
| Evolutions Health Care Contracted [320124] | $121 | 345% |
| Imagine 360 Contracted [320494] | $121 | 345% |
| Point C [20238] | $121 | 345% |
| Aither Health Contracted [320449] | $121 | 345% |
| 90 Degree Benefits Contracted [320436] | $121 | 345% |