Occupational therapy (therapeutic activities)
Facility: Community Memorial Healthcare, Inc.
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $35
- Cash Discount Price: $62
- vs. Medicare Baseline: 1.00x 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 |
|---|---|---|
| Aetna | $28 - $50 | 80% |
| UnitedHealthcare | $35 | 100% |
| Blue Cross Blue Shield | $57 | 163% |
Consumer Guidance & Cost Commentary
For Occupational therapy (therapeutic activities) at Community Memorial Healthcare, Inc. in Marysville, KS, the cash price is $62.00, which matches the facility's median negotiated rate and the state average. This service is billed under CPT code 97530, and while the Medicare benchmark is $35.07, the facility's cash rate is significantly higher. Patients with high-deductible plans or those without insurance may find paying the full cash price of $62.00 more cost-effective than using insurance, as commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront incentives can reduce the final amount owed by bypassing the standard insurance billing cycle.
The facility is a Voluntary non-profit Critical Access Hospital with a 4-star rating, and the data reflects a 2026-06 vintage. While the specific county average is not provided in this dataset, the facility's cash rate aligns with the state median, suggesting consistent pricing within the region. If you have received a bill, it is important to request a detailed, itemized statement to verify that all charges correspond to services actually rendered and to check for potential errors such as code unbundling or duplicate billing. Under federal protections like the No Surprises Act, you are generally shielded from balance billing for out-of-network services at in-network facilities, so you should dispute any unexpected charges with the insurer rather than paying immediately. Always verify your deductible status before scheduling, as you may be responsible for the full negotiated amount if your plan has not yet met