Occupational therapy (therapeutic activities)
Facility: Providence Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $35
- Cash Discount Price: $32
- vs. Medicare Baseline: 1.00x 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 |
|---|---|---|
| Aetna | $27 - $53 | 77% |
| Medicaid / KanCare | $28 | 80% |
| UnitedHealthcare | $28 - $137 | 80% |
| Celtic | $29 - $53 | 83% |
| Healthy Blue | $29 - $35 | 83% |
| Midland Care Connection | $33 | 94% |
| Tricare | $33 | 94% |
| Cigna | $33 | 94% |
| Blue Cross Blue Shield | $33 - $78 | 94% |
| Medicare (plans) | $33 | 94% |
| Kansas Superior Select | $35 | 100% |
| Corizon | $43 | 123% |
| Employer Direct Healthcare | $46 | 131% |
| Well Path Prison | $46 | 131% |
| Centurion | $49 | 140% |
| Naphcare | $51 | 145% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Providence Medical Center in Kansas City, KS, the negotiated rates vary significantly by payer, ranging from $27 to $137. While the facility's cash median is $32.00, which is notably lower than the lowest negotiated rate of $27 found with Aetna, patients with high-deductible plans may find paying cash upfront more cost-effective than relying on insurance, as the administrative overhead often inflates commercial rates. It is important to note that the facility's cash price is substantially lower than the state average for this procedure, and patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling to bypass the higher insurance negotiated rates.
The facility's negotiated rates are generally higher than the Medicare benchmark of $35.07, with most commercial payers charging between $28 and $53, reflecting the typical administrative markup associated with insurance billing. For instance, UnitedHealthcare's range extends up to $137, while Medicaid/KanCare and Medicare plans remain closer to the $28–$35 range. To avoid unexpected balance billing, patients should verify their specific plan's allowed amount and ensure they do not sign away rights to dispute out-of-network charges, as federal protections like the No Surprises Act may apply depending on the service setting. Ultimately, comparing the $32 cash median against the $196 median paid by insurers highlights the potential savings available when negotiating directly with the hospital.