Occupational therapy (therapeutic activities)
Facility: Ellinwood District Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $53
- Cash Discount Price: $64
- vs. Medicare Baseline: 1.51x 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 | $52 | 148% |
| Blue Cross Blue Shield | $52 | 148% |
| Aetna | $52 | 148% |
| Cigna | $52 | 148% |
| Humana | $52 | 148% |
Consumer Guidance & Cost Commentary
For this Occupational therapy session at Ellinwood District Hospital, the negotiated payment rate of $53.00 is consistent across all five major payers, including UnitedHealthcare, Blue Cross Blue Shield, Aetna, Cigna, and Humana. This negotiated amount aligns exactly with the facility's median negotiated rate and the median paid amount reported for this service. While the facility's cash price of $64.00 is higher than the negotiated rate, patients with high-deductible plans may find the cash price more affordable if their insurance allowed amount exceeds $64.00, as paying out-of-pocket could result in lower total costs. It is important to note that the facility is a Critical Access Hospital in Ellinwood, Kansas, and while specific state or county average data is not provided in this report, the fixed negotiated rates across multiple insurers suggest a standardized pricing structure for this procedure within the network.
The Medicare benchmark for this service is $35.07, which serves as a cost-based baseline for evaluating pricing fairness. The facility's gross charge of $75.00 represents a significant markup over the Medicare rate, but the negotiated rate of $53.00 reflects the actual amount commercial insurers pay after accounting for administrative costs and contract terms. To minimize potential costs, patients should inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront. Additionally, if you are receiving care from an out-of-network provider or if ancillary services like lab work are billed separately, you may be subject to balance billing; however, the No Surprises Act protects