Occupational therapy (therapeutic activities)
Facility: Morris County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $64
- Cash Discount Price: $59
- vs. Medicare Baseline: 1.82x 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 |
|---|---|---|
| Blue Cross Blue Shield | $39 - $57 | 111% |
| Va Ccn-All Plans | $39 | 111% |
| Choice Care Mcr Adv-All Plans | $39 | 111% |
| Coventry Mcr | $39 | 111% |
| UnitedHealthcare | $39 - $99 | 111% |
| Cigna | $72 | 205% |
| Coventry Comm-All Other Plans | $89 | 254% |
| Aetna | $89 | 254% |
| Multiplan-All Plans | $89 | 254% |
| Providrs Care (Wppa)(Nexus)-All Plans | $148 | 422% |
Consumer Guidance & Cost Commentary
For CPT code 97530, Occupational therapy (therapeutic activities), Morris County Hospital in Council Grove, KS, lists a gross charge of $99.00. While the facility's cash median rate is $59.00, the negotiated rates paid by insurance plans range from $39.00 to $148.00, with most major payers like Blue Cross Blue Shield, Va Ccn-All Plans, and Choice Care Mcr Adv-All Plans settling at $39.00. It is important to note that for patients with high-deductible plans, paying the cash price of $59.00 upfront may be more cost-effective than relying on insurance, as the negotiated rates for many carriers exceed the cash amount. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can further reduce the final bill.
When evaluating the cost relative to federal standards, the facility's cash rate of $59.00 is 1.8 times the Medicare amount of $35.07 for this service. The median negotiated rate of $64.00 reflects the administrative costs and contract dynamics inherent in commercial insurance billing, which often result in higher prices than direct cash payment. Although the facility is a Critical Access Hospital with government-local ownership, patients should remain vigilant regarding balance billing if they receive out-of-network ancillary services, as the No Surprises Act protects against such unexpected charges for emergency and non-emergency care at in-network facilities. To ensure accuracy, consumers should request a full itemized bill before paying, as summary invoices may obscure unbundled