Occupational therapy (therapeutic activities)
Facility: Menorah Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $46
- Cash Discount Price: $241
- vs. Medicare Baseline: 1.31x 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 |
|---|---|---|
| United | $28 - $108 | 80% |
| Amerigroup | $28 | 80% |
| Humana | $29 - $76 | 83% |
| Medicaid / KanCare | $29 | 83% |
| Coventry | $29 - $97 | 83% |
| Healthyblue | $29 | 83% |
| Devoted Health | $29 - $33 | 83% |
| Blue Cross Blue Shield | $29 - $108 | 83% |
| Cigna | $30 - $192 | 86% |
| Celtic | $30 - $34 | 86% |
| Unicare | $30 | 86% |
| Wellcare | $30 - $34 | 86% |
| Aetna | $30 - $123 | 86% |
| Pyramid Life | $31 - $35 | 88% |
| Home State Health Plan | $32 | 91% |
| Triwest Health Alliance | $33 | 94% |
| Multiplan | $44 - $178 | 125% |
| Ambetter / Centene | $45 | 128% |
| Nhc Advantage | $46 | 131% |
| Oscar | $46 | 131% |
| Wppa Providrs Care Network | $48 | 137% |
| Corvel Corporation | $52 - $156 | 148% |
| Oha Network | $54 - $120 | 154% |
| Universal Healthcare | $84 | 240% |
| Coventry Kc Mo | $99 | 282% |
| College Park Family Care Center | $103 | 294% |
| Focus Healthcare Mgmt, Inc | $180 | 513% |
| Cco, Inc. | $180 | 513% |
Consumer Guidance & Cost Commentary
For the CPT code 97530, representing occupational therapy therapeutic activities, Menorah Medical Center in Overland Park, KS, lists a cash price of $241.00. This cash rate is significantly higher than the facility's negotiated rates, which range from $28 to $180 across 28 different payers, with a median negotiated amount of $46.00. While commercial insurance contracts often cap payments at these negotiated levels, patients with high-deductible plans may find that paying the cash price directly is more cost-effective than having insurance cover a service where the allowed amount exceeds the cash rate. It is important to verify your specific plan's deductible status before scheduling, as paying out-of-pocket can sometimes result in lower total costs than the insurance process.
When evaluating the facility's pricing against broader benchmarks, the Medicare amount for this service is set at $35.07. The facility's cash price of $241.00 represents a markup of 1.3 times the Medicare rate, which is consistent with commercial pricing structures that often range from 200% to 300% of Medicare. To maximize savings, patients should inquire about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% if paid in full upfront, bypassing the administrative overhead associated with insurance claims. Additionally, if you receive a bill after using insurance, request a detailed itemized audit to identify any errors, double-billing, or unbundled charges, as over 80% of hospital bills contain mistakes that can be corrected before payment.