Occupational therapy (therapeutic activities)
Facility: Wesley Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $47
- Cash Discount Price: $443
- vs. Medicare Baseline: 1.34x 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 |
|---|---|---|
| UnitedHealthcare | $28 | 80% |
| Coventry Health Care | $29 - $33 | 83% |
| Humana | $29 - $33 | 83% |
| Devoted Health | $29 - $33 | 83% |
| Aetna | $29 - $200 | 83% |
| Medicaid / KanCare | $29 | 83% |
| Ambetter / Centene | $30 - $80 | 86% |
| Amerigroup | $30 | 86% |
| United | $30 - $199 | 86% |
| Triwest Health Alliance | $33 | 94% |
| Correct Care Solutions | $44 - $49 | 125% |
| First Health | $52 - $204 | 148% |
| Multiplan | $54 - $399 | 154% |
| Blue Cross Blue Shield | $57 | 163% |
| Health Partners Of Kansas | $77 - $222 | 220% |
| Wppa | $77 | 220% |
| Preferred Health Choices | $84 | 240% |
| Medical Associates Health Plan | $84 | 240% |
| Spirit Aerosystems | $142 | 405% |
| Triwest Healthcare Alliance | $288 | 821% |
| Usa Managed Care | $377 | 1075% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Wesley Medical Center in Wichita, KS, the cash price is $443.00, which matches the facility's cash median. This rate is significantly higher than the state average, as the Medicare benchmark for this code is only $35.07, indicating a substantial markup relative to the federal baseline. While many insurance plans in Kansas negotiate rates ranging from $28 to $204, the cash price remains the lowest fixed amount available for this specific procedure. Patients with high-deductible plans or those who have already met their out-of-pocket maximums may find that paying the cash price directly is more cost-effective than relying on insurance, which could result in higher allowed amounts or balance billing if the patient is out-of-network.
To minimize costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the bill by 20% to 50%. It is important to note that even if a payer has a negotiated rate, the final cost depends on whether the patient's deductible has been met; if not, the patient may be responsible for the full negotiated amount, which often exceeds the cash price. Additionally, patients should request a detailed, itemized bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. If a balance bill arises from an out-of-network provider, patients can utilize the No Surprises Act to dispute the charge, ensuring they are not billed for the difference between the provider's rate and the insurance allowed amount.