Occupational therapy (therapeutic activities)
Facility: Pratt Regional Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $92
- Cash Discount Price: $77
- vs. Medicare Baseline: 2.62x 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 262% of the Medicare baseline (a markup of 162%). 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 |
|---|---|---|
| Celtic Insurance Company | $34 | 97% |
| Healthy Blue | $35 | 100% |
| UnitedHealthcare | $38 - $130 | 108% |
| Christian Health Aid | $67 - $95 | 191% |
| Health Partners Of Kansas | $76 - $108 | 217% |
| Aetna | $80 - $114 | 228% |
| Choicecare | $89 - $127 | 254% |
Consumer Guidance & Cost Commentary
For Occupational therapy (therapeutic activities) at Pratt Regional Medical Center in Pratt, KS, the cash median price is $77.00, which is lower than the facility's gross charge of $110.00. While the facility's negotiated rates with major payers like UnitedHealthcare and Aetna range from $38 to $130, patients with high-deductible plans may find paying the cash median of $77.00 upfront more cost-effective than relying on insurance, as the negotiated rates often exceed the cash price. To maximize savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
The facility's pricing is benchmarked against the Medicare rate of $35.07 for this service, showing a markup of 2.6 times the Medicare amount. Although the facility is an Acute Care Hospital with a Proprietary ownership structure, the cash rate of $77.00 remains a significant portion of the gross charge, highlighting the importance of verifying actual allowed amounts rather than relying on the hospital's list price. Consumers are advised to review their specific insurance plan details to understand deductibles and co-pays, as paying the negotiated rate could result in higher out-of-pocket costs if the patient has not yet met their deductible. Always obtain an itemized bill before payment to ensure all charges are accurate and to identify any potential errors or unbundled codes.