Occupational therapy (therapeutic activities)
Facility: Hospital District #6 Patterson Health Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $75
- Cash Discount Price: $66
- vs. Medicare Baseline: 2.14x 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 214% of the Medicare baseline (a markup of 114%). 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 | $47 - $49 | 134% |
| UnitedHealthcare | $75 - $83 | 214% |
| Providers Care (Wppa)-All Plans | $145 | 413% |
Consumer Guidance & Cost Commentary
For the CPT code 97530, representing occupational therapy therapeutic activities, the facility's cash median rate of $66.00 is lower than the negotiated rates paid by major insurers like UnitedHealthcare ($75.00) and Blue Cross Blue Shield ($47.00 to $49.00). This price transparency data highlights that while in-network insurance contracts often set a ceiling to protect members, the actual cost to a patient can vary significantly based on their plan's deductible status and the specific payer. In this case, the cash price of $66.00 is notably lower than the median negotiated amount of $75.00, suggesting that patients with high-deductible plans might save money by paying out-of-pocket, provided they verify that the insurance allowed amount does not exceed the cash rate.
The facility, a Critical Access Hospital in Anthony, KS, lists a Medicare amount of $35.07, which serves as a key benchmark for evaluating the facility's pricing markup. Commercial negotiated rates often exceed Medicare benchmarks due to administrative overhead and contract dynamics, but the cash rate of $66.00 remains below the gross charge of $83.00. Patients should be aware that hospitals frequently offer prompt-pay discounts for upfront cash payments, which can further reduce the final bill by bypassing the administrative costs associated with insurance claims processing. To ensure you are receiving the best possible rate, it is advisable to contact the hospital directly to confirm self-pay or prompt-pay discounts before scheduling your visit, rather than relying solely on the insurance allowed amount.