Occupational therapy (therapeutic activities)
Facility: Greenwood County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $55
- Cash Discount Price: $52
- vs. Medicare Baseline: 1.57x 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 |
|---|---|---|
| Triwest - All Plans | $23 | 66% |
| Choicecare Mcr Adv - All Plans | $27 | 77% |
| UnitedHealthcare | $27 - $55 | 77% |
| Tricare | $27 | 77% |
| Blue Cross Blue Shield | $47 - $49 | 134% |
| Integrated Health Plan - All Plans | $49 | 140% |
| Beech Street - All Plans | $55 | 157% |
| First Health - All Other Plans | $55 | 157% |
| First Health Ccn Network | $55 | 157% |
| Preferred Hs (Coventry) - All Plans | $58 | 165% |
| Principal Health Care Inc - All Plans | $62 | 177% |
| Medicaid / KanCare | $65 | 185% |
| Amerigroup Mcaid-All Plans | $65 | 185% |
| Providrs Care/Wppa - All Plans | $97 | 277% |
Consumer Guidance & Cost Commentary
For CPT code 97530, representing occupational therapy therapeutic activities, Greenwood County Hospital in Eureka, Kansas, lists a cash median price of $52.00 and a median negotiated rate of $55.00. This facility, a Critical Access Hospital owned by the local government, charges significantly less than the gross amount of $65.00. While the negotiated rates for commercial payers range from $23 to $97 depending on the insurance plan, the cash price of $52.00 is notably lower than the median negotiated amount of $55.00. For patients with high-deductible plans who have not yet met their out-of-pocket maximum, paying the cash price directly may result in lower total costs compared to the insurance negotiated rate, which often includes administrative overheads that inflate the baseline price.
The facility's pricing structure is evaluated against federal benchmarks, showing a ratio of 1.6 times the Medicare amount of $35.07. While specific county or state average comparisons are not provided in this dataset, the data highlights that the cash rate is the most transparent figure available for direct comparison. Patients should be aware that commercial insurance contracts often establish a ceiling rate that protects in-network members but can exceed the cash price due to multi-layered administrative structures. To ensure the best financial outcome, it is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final bill by bypassing costly claims processing and collection fees.