Occupational therapy (therapeutic activities)
Facility: Fredonia Regional Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $87
- Cash Discount Price: $97
- vs. Medicare Baseline: 2.48x 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 248% of the Medicare baseline (a markup of 148%). 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 | $48 - $57 | 137% |
| Veterans Programs - All Plans | $49 | 140% |
| Aetna | $49 - $87 | 140% |
| UnitedHealthcare | $49 - $229 | 140% |
| Reserve National-All Plans | $87 | 248% |
| Meritain-All Plans | $87 | 248% |
| Cigna | $87 | 248% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Fredonia Regional Hospital in Kansas, the cash price is $97.00, which matches the facility's median negotiated rate of $87.00 and the cash median of $97.00. While the facility is a Critical Access Hospital with government-local ownership, patients should note that commercial insurance negotiated rates for this service range widely across payers, from $48 to $229, with UnitedHealthcare showing the highest variance. Because the cash price ($97.00) is lower than the median negotiated amount ($87.00) and the Medicare benchmark ($35.07), paying out-of-pocket may be the most cost-effective option for individuals with high-deductible plans or those without insurance. To maximize savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
It is important to distinguish between the facility's gross charge of $97.00 and the actual amounts paid by insurers, which vary significantly based on the specific plan. For instance, while Blue Cross Blue Shield plans pay between $48 and $57, and Aetna plans range from $49 to $87, the Medicare allowed amount is set at $35.07. This disparity highlights why comparing rates against the Medicare benchmark is more accurate than looking at the hospital's list price; commercial rates often include administrative markups that do not reflect the true cost of care. If you receive a bill that exceeds these negotiated or cash rates,