Occupational therapy (therapeutic activities)
Facility: Republic County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $73
- Cash Discount Price: $59
- vs. Medicare Baseline: 2.08x 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 208% of the Medicare baseline (a markup of 108%). 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 |
|---|---|---|
| Rural Carriers-All Plans | $67 | 191% |
| Aetna | $71 | 202% |
| Meritain-All Plans | $71 | 202% |
| UnitedHealthcare | $73 | 208% |
| Midlands Choice-All Plans | $75 | 214% |
| First Health-All Plans | $75 | 214% |
| Cigna | $75 | 214% |
Consumer Guidance & Cost Commentary
For this Occupational therapy service at Republic County Hospital in Belleville, KS, the facility's negotiated rates for commercial insurance range from $67 to $75, while the cash price is $59. This cash rate is notably lower than the facility's negotiated rates, which aligns with the national trend where commercial insurance contracts often exceed cash prices due to administrative overhead and contract structures. The facility's cash price of $59 is also lower than the state average for this service, making it a potentially cost-effective option for patients with high-deductible plans who may not yet have met their insurance coverage thresholds.
To maximize savings, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership, the negotiated rates for this specific CPT code are significantly higher than the Medicare benchmark of $35.07, reflecting the typical markup found in commercial pricing. Consumers are advised to request an itemized bill before scheduling to ensure no unexpected charges are included and to confirm that the facility has applied the most favorable cash or negotiated rate available.