Occupational therapy (therapeutic activities)
Facility: Memorial Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $80
- Cash Discount Price: $115
- 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 |
|---|---|---|
| Tricare | $47 - $73 | 134% |
| Humana | $47 - $73 | 134% |
| Medicare (plans) | $47 - $73 | 134% |
| Blue Cross Blue Shield | $52 | 148% |
| Ambetter / Centene | $52 - $80 | 148% |
| Coventry - All Other Plans | $84 - $131 | 240% |
| Health Partners Of Kansas - All Plans | $89 - $138 | 254% |
| Preferred Healthcare-All Plans | $89 - $138 | 254% |
| Wppa/Providers Care-All Plans | $131 - $203 | 374% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service at Memorial Hospital in Abilene, KS, the cash price is $115.00, which matches the facility's cash median. This rate is significantly higher than the state average, which is $89.00. While commercial insurance plans like Coventry and Health Partners Of Kansas have negotiated rates ranging from $84 to $138, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance allowed amount exceeds $115.00. Because the facility is a Critical Access Hospital owned by a Government Hospital District, it is important to verify your specific plan's negotiated rate before scheduling, as in-network contracts can vary widely even within the same region.
To minimize unexpected costs, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% when paid in full upfront. This bypasses the administrative overhead associated with insurance claims processing and avoids potential balance billing scenarios, especially if ancillary services are out-of-network. Since over 80% of hospital bills contain errors, consumers are advised to request a detailed, itemized statement before making any payment to ensure no services were double-billed or unbundled. Always confirm your deductible status and the exact allowed amount with the billing department prior to treatment to avoid paying the full negotiated rate without insurance coverage.