Occupational therapy (therapeutic activities)
Facility: Ellsworth County Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $59
- Cash Discount Price: $66
- vs. Medicare Baseline: 1.68x 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 |
|---|---|---|
| Humana | $29 - $66 | 83% |
| Va Ccn-All Plans | $29 - $32 | 83% |
| Healthy Blue Mcr Adv | $29 - $32 | 83% |
| Triwest -All Plans | $29 - $32 | 83% |
| UnitedHealthcare | $40 - $69 | 114% |
| Blue Cross Blue Shield | $47 - $49 | 134% |
| First Health - All Plans | $56 - $62 | 160% |
| Aetna | $56 - $62 | 160% |
| Cigna | $59 - $66 | 168% |
| Healthy Blue Mcaid- All Other Plans | $62 - $69 | 177% |
| Medicaid / KanCare | $62 - $69 | 177% |
| Coventry Mcaid-All Plans | $62 - $69 | 177% |
| Providers Care-Wppa-All Plans | $93 - $104 | 265% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Ellsworth County Medical Center, the cash price is $66.00, which matches the facility's cash median. This rate is significantly higher than the state average of $50.00, meaning patients paying out-of-pocket are paying 32% more than the typical negotiated rate in Kansas. While commercial insurance plans like Humana and several Kansas Medicaid plans negotiate rates as low as $29.00, these amounts often exceed the cash price of $66.00 when adjusted for plan specifics, suggesting that for some high-deductible plans, paying cash upfront could result in lower out-of-pocket costs. Patients should verify their specific deductible status and ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
When comparing this service to the Medicare benchmark of $35.07, the facility's gross charge of $66.00 represents a markup of 1.7 times the federal rate, indicating a substantial premium over the government's calculated cost baseline. Although the facility is a Critical Access Hospital in Ellsworth, KS, with a proprietary ownership structure, the negotiated rates for in-network payers range from $29.00 to $69.00, with a median negotiated amount of $59.00. Because the No Surprises Act prohibits balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, patients should avoid paying surprise bills immediately upon receiving an invoice. Instead, they should request a full