Occupational therapy (therapeutic activities)
Facility: Wilson Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $90
- Cash Discount Price: $84
- vs. Medicare Baseline: 2.57x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 257% of the Medicare baseline (a markup of 157%). 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 - $112 | 140% |
| Tricare | $59 | 168% |
| Aetna | $59 - $112 | 168% |
| Humana | $59 | 168% |
| UnitedHealthcare | $59 - $104 | 168% |
| Ambetter / Centene | $59 - $112 | 168% |
| Cigna | $90 | 257% |
| Health Partners-All Plans | $103 | 294% |
| Mulitplan-All Plans | $103 | 294% |
Consumer Guidance & Cost Commentary
For the CPT code 97530, representing occupational therapy therapeutic activities, the gross charge at Wilson Medical Center in Neodesha, KS, is $112.00. This facility, a Critical Access Hospital owned by the local government, has negotiated rates ranging from $49 to $112 across nine different payers, with the highest negotiated amount being $112.00 (Blue Cross Blue Shield, Aetna, Ambetter/Centene) and the lowest being $49.00 (Blue Cross Blue Shield). When compared to the national average, the cash-pay median of $84.00 is 2.6 times the Medicare benchmark of $35.07. While the median amount paid by insurers is $65.00, patients with high-deductible plans may find the cash price of $84.00 more cost-effective than the negotiated rates if their out-of-pocket costs exceed the difference between the cash price and the insurer's allowed amount.
To minimize costs, patients should proactively contact Wilson Medical Center to inquire about "self-pay" or "prompt-pay" discounts, which can significantly reduce the final bill by bypassing administrative claim processing fees. It is important to verify that the facility is truly in-network for your specific plan, as in-network status does not guarantee the lowest possible price, and some commercial rates can exceed the cash price. Additionally, since over 80% of hospital bills often contain errors, consumers are encouraged to request a detailed, itemized bill to review every line item for potential coding mistakes or unbundled charges before making any payment.