Occupational therapy (therapeutic activities)
Facility: Phillips County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $63
- Cash Discount Price: $56
- vs. Medicare Baseline: 1.80x 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 |
|---|---|---|
| UnitedHealthcare | $50 - $68 | 143% |
| Blue Cross Blue Shield | $51 - $57 | 145% |
| Health Partners-All Plans | $63 - $68 | 180% |
| Medicaid / KanCare | $63 - $68 | 180% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Phillips County Hospital in Phillipsburg, KS, the cash median price of $56.00 is notably lower than the facility's negotiated rates, which range from $50.00 to $68.00 depending on the insurance carrier. While the facility is a Critical Access Hospital with government-local ownership, patients should be aware that commercial insurance plans, such as UnitedHealthcare and Blue Cross Blue Shield, often pay significantly more than the cash price due to administrative processing costs and contract structures. If you have a high-deductible plan or have not yet met your deductible, paying the cash price upfront could result in immediate savings compared to the higher amounts your insurer would negotiate and pay.
To maximize your savings, it is essential to request a "self-pay" or "prompt-pay" discount directly from the hospital before scheduling your visit, as these upfront payment incentives can reduce the final bill by 20% to 50%. Additionally, since the Medicare benchmark for this procedure is $35.07, the facility's cash rate of $56.00 represents a markup of approximately 1.8 times the Medicare amount, which is higher than the typical fair pricing range of 120% to 150% of Medicare. If you receive a bill that includes unexpected charges or appears to be a summary rather than a detailed itemized statement, you should request a full line-by-line audit to identify any errors, unbundled codes, or services not rendered before making any payment.