Occupational therapy (therapeutic activities)
Facility: Saint John Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $34
- Cash Discount Price: $32
- vs. Medicare Baseline: 0.97x 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.
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 |
|---|---|---|
| Blue Cross Blue Shield | $27 - $57 | 77% |
| Medicaid / KanCare | $28 | 80% |
| UnitedHealthcare | $28 - $46 | 80% |
| Celtic | $29 - $99 | 83% |
| Healthy Blue | $29 - $35 | 83% |
| Medicare (plans) | $33 | 94% |
| Tricare | $33 | 94% |
| Midland Care Connection | $33 | 94% |
| Cigna | $33 | 94% |
| Aetna | $33 - $53 | 94% |
| Kansas Superior Select | $34 | 97% |
| Corizon | $46 | 131% |
| Well Path | $46 | 131% |
| Employer Direct Healthcare | $46 | 131% |
| Centurion | $49 | 140% |
| Naphcare | $51 | 145% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Saint John Hospital in Leavenworth, KS, the cash price of $32.00 is significantly lower than the facility's negotiated rates, which range from $27 to $99 depending on the insurance plan. While the median negotiated amount paid by insurers is $116.00, the cash price represents a substantial discount. It is important to note that for patients with high-deductible plans, paying the cash price upfront can be more cost-effective than relying on insurance, as the negotiated rate often exceeds the cash price. Additionally, patients should inquire about "prompt-pay" discounts, which may offer further reductions for those who settle their bill in full within 30 days, bypassing the administrative costs associated with insurance claims processing.
The facility's cash price of $32.00 is notably lower than the Medicare benchmark of $35.07, which serves as a reliable baseline for fair pricing. Although the facility is an Acute Care Hospital with a voluntary non-profit ownership structure, the wide variance in negotiated rates across 16 different payers highlights that in-network coverage does not guarantee the lowest possible cost. To avoid unexpected balance billing or errors, patients are advised to request a detailed, itemized bill before paying and to verify that all services rendered are accurately coded. If a balance bill arises from out-of-network ancillary services, patients should utilize the No Surprises Act to dispute the charge rather than paying immediately out of fear of credit damage.