Occupational therapy (therapeutic activities)
Facility: Via Christi Hospital Wichita St Teresa, Inc
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $33
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.94x 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 | $33 - $91 | 94% |
| Via Christi Research | $33 | 94% |
| Va | $33 | 94% |
| Vc Hope | $33 | 94% |
| Saint Lukes Health Systems | $33 | 94% |
| Medicare (plans) | $33 | 94% |
| Blue Cross Blue Shield | $33 | 94% |
| Humana | $33 | 94% |
| Corizon | $41 | 117% |
| Smarthealth | $46 | 131% |
| Medicaid / KanCare | $55 | 157% |
| Coventry City Of Wichita | $77 | 220% |
| Aetna | $118 | 336% |
Consumer Guidance & Cost Commentary
For CPT code 97530, representing occupational therapy therapeutic activities, the negotiated rates across 13 payers range from $33 to $118, with a median negotiated amount of $33. This facility's rates are significantly lower than the state average for Kansas, where the median negotiated rate is $41. While commercial insurance contracts cap payments at these negotiated levels, patients with high-deductible plans may find cash-paying cheaper if the facility offers a self-pay or prompt-pay discount, as insurance negotiated rates often exceed cash prices due to administrative overhead. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, patients should still verify their specific plan details and request a waiver of insurance submission before scheduling to avoid unexpected claims processing.
The facility, Via Christi Hospital Wichita St Teresa, Inc, is a voluntary non-profit church-owned acute care hospital located in Wichita, KS, with a Medicare benchmark rate of $35.07 for this service. Comparing this to the national average, the facility's rates are 90% of the Medicare amount, indicating pricing that is generally aligned with or below the federal cost baseline. However, patients should be aware that summary bills often obscure individual line items, and over 80% of hospital bills contain errors such as unbundled codes or services not rendered. To ensure accuracy, consumers should request a full itemized CPT-coded bill before negotiating or paying, and if they receive a balance bill, they should dispute it in writing with the insurer rather than accepting the charge immediately.