Occupational therapy (therapeutic activities)
Facility: Susan B Allen Memorial Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $554
- Cash Discount Price: $57
- vs. Medicare Baseline: 15.80x 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 1580% of the Medicare baseline (a markup of 1480%). 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 |
|---|---|---|
| UnitedHealthcare | $350 | 998% |
| Providrs Care | $757 | 2159% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Susan B Allen Memorial Hospital in El Dorado, KS, the cash price of $57.00 is significantly lower than the facility's negotiated rates of $554.00 and the state average of $350.00. While the facility's negotiated rate is higher than the state average, the cash price remains the most affordable option available, sitting well below the state average and the negotiated amounts. This price difference highlights that paying out-of-pocket can be a strategic choice for patients with high-deductible plans, as the cash price avoids the substantial administrative markup inherent in insurance billing cycles.
To maximize savings, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling their visit, as these upfront payment incentives can further reduce the final bill. It is important to note that while the cash rate is already favorable compared to the state average, verifying the specific discount terms with the hospital's billing department is essential, as automatic claims submission can sometimes void cash agreements. Additionally, since the Medicare benchmark for this service is $35.07, the cash price of $57.00 represents a reasonable cost relative to the federal baseline, offering a transparent and predictable expense without the risk of unexpected balance billing associated with out-of-network scenarios.