Occupational therapy (therapeutic activities)
Facility: Osborne County Memorial Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $80
- Cash Discount Price: $75
- vs. Medicare Baseline: 2.28x 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 228% of the Medicare baseline (a markup of 128%). 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 |
|---|---|---|
| UnitedHealthcare | $66 - $67 | 188% |
| Health Partners Of Kansas | $75 - $76 | 214% |
| Wppa | $83 - $84 | 237% |
| Blue Cross Blue Shield | $85 - $86 | 242% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Osborne County Memorial Hospital in Osborne, KS, the cash median price is $75.00, which is notably lower than the facility's negotiated rates of $80.00 and the gross charge of $88.00. While the facility is a Critical Access Hospital with government-local ownership, patients should be aware that cash payments can sometimes be more cost-effective than using insurance, particularly if their plan has a high deductible or if the insurer's negotiated rate exceeds the cash price. It is important to verify your specific plan's allowed amount before scheduling, as in-network rates vary significantly even within the same network.
The Medicare benchmark for this service is $35.07, which serves as a key reference point for evaluating the facility's pricing structure. The cash rate of $75.00 represents a markup relative to the Medicare amount, while the negotiated rates for payers like UnitedHealthcare, Health Partners Of Kansas, Wppa, and Blue Cross Blue Shield range from $66 to $86. If you are self-pay, you may qualify for a prompt-pay discount by requesting a self-pay classification before check-in, which can reduce the final bill. Additionally, if you receive care from an out-of-network provider at this facility, the No Surprises Act generally protects you from balance billing for emergency and non-emergency services, though you should always review your itemized bill to ensure no unbundled codes or services not rendered are included.