Occupational therapy (therapeutic activities)
Facility: Great Plains Of Sabetha
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $66
- Cash Discount Price: $68
- vs. Medicare Baseline: 1.88x 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 |
|---|---|---|
| Celtic Mcr Adv | $35 - $49 | 100% |
| Aetna | $35 - $96 | 100% |
| Celtic Comm Exchange-All Other Plans | $44 - $62 | 125% |
| Great West Healthcare-All Plans | $57 - $81 | 163% |
| UnitedHealthcare | $62 - $95 | 177% |
| Cigna | $64 - $90 | 182% |
| Humana | $64 - $90 | 182% |
| Century/Wppa/Providers-All Plans | $64 - $90 | 182% |
| Federated Mutual Ins-All Plans | $64 - $91 | 182% |
| Multiplan-Phcs-All Plans | $64 - $90 | 182% |
| Blue Cross Blue Shield | $67 - $95 | 191% |
| Medicaid / KanCare | $67 - $95 | 191% |
Consumer Guidance & Cost Commentary
This report details the pricing for Occupational therapy (therapeutic activities), CPT code 97530, at Great Plains Of Sabetha in Sabetha, KS. The facility's cash median rate is $68.00, which matches the cash median for this service in the state. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics. For instance, the median negotiated rate across payers is $66.00, and the highest allowed amounts reach up to $96.00 for Aetna plans. Consequently, patients with high-deductible plans or those paying out-of-pocket may find the cash price of $68.00 to be the most economical option, as it avoids the multi-layered billing structures inherent in insurance claims.
To ensure you are receiving the best possible price, it is crucial to verify your specific plan's allowed amount before scheduling, as rates vary significantly by insurer, ranging from $35.00 for Celtic Mcr Adv to $96.00 for Aetna. If you choose to use insurance, be mindful of balance billing risks, particularly if you receive out-of-network ancillary services like emergency care or specific lab tests, which can trigger unexpected bills despite federal protections for emergency services at in-network facilities. Furthermore, since over 80% of hospital bills contain errors, always request a full itemized CPT-coded statement rather than accepting a summary bill, and consider disputing any discrepancies in writing to avoid unnecessary debt. Finally, ask the billing department about prompt-pay discounts, which can reduce your