Occupational therapy (therapeutic activities)
Facility: Rawlins County Health Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $87
- Cash Discount Price: $89
- vs. Medicare Baseline: 2.48x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 248% of the Medicare baseline (a markup of 148%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Blue Cross Blue Shield | $49 | 140% |
| UnitedHealthcare | $87 - $96 | 248% |
Consumer Guidance & Cost Commentary
For this Occupational therapy service at Rawlins County Health Center in Atwood, KS, the cash price is $89.00, which is notably lower than the facility's negotiated rate of $87.00 and the Medicare benchmark of $35.07. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance plans like Blue Cross Blue Shield and UnitedHealthcare are expected to pay significantly higher amounts due to administrative overhead and contract dynamics. Specifically, Blue Cross Blue Shield pays a flat $49, while UnitedHealthcare pays between $87 and $96 depending on the specific plan. If you have a high-deductible plan or have not yet met your deductible, paying the cash price of $89.00 upfront may result in immediate savings compared to the insurance negotiated rates, provided you can secure a prompt-pay discount from the hospital before the claim is submitted.
It is important to distinguish between the facility's gross charge of $105.00 and the actual amounts paid, as the latter reflects the true cost to the patient or insurer. The data indicates that the cash median of $89.00 is the most reliable figure for self-pay patients, as it avoids the multi-layered administrative structures that inflate commercial negotiated rates. If you are concerned about balance billing or unexpected charges, remember that the No Surprises Act protects you from being billed the difference between the provider's full list price and your insurance allowed amount for emergency care or non-emergency services at in-network facilities. To ensure you are not overcharged, always request a full itemized bill before paying, verify that all services rendered are accurately coded