Occupational therapy (therapeutic activities)
Facility: Bob Wilson Memorial Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $110
- Cash Discount Price: $57
- vs. Medicare Baseline: 3.14x 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 314% of the Medicare baseline (a markup of 214%). 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 | $39 - $136 | 111% |
| Aetna | $39 - $131 | 111% |
| Medicare (plans) | $39 - $52 | 111% |
| Humana | $39 - $52 | 111% |
| Kansas Health | $39 - $52 | 111% |
| Centura Employee Plan | $72 | 205% |
| Blue Cross Blue Shield | $76 | 217% |
| Multiplan | $110 - $152 | 314% |
| Health Partners Of Kansas | $115 - $154 | 328% |
| Wppa | $116 - $155 | 331% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service at Bob Wilson Memorial Hospital in Ulysses, KS, the cash price of $57.00 is significantly lower than the facility's negotiated rates with major insurers. While the hospital's cash median is $57.00, commercial payers like UnitedHealthcare and Aetna negotiate rates ranging from $39 to $136, and Medicare allows a payment of $35.07. This disparity highlights that for patients with high-deductible plans or those without insurance, paying the cash price directly can result in substantial savings compared to insurance reimbursement. However, patients should verify if their specific plan has a deductible that must be met before these lower cash rates apply, as some commercial contracts may require the patient to pay the full negotiated amount first.
To ensure you are not overcharged, it is critical to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you receive a balance bill for out-of-network services, you may be protected under the No Surprises Act, which bans balance billing for emergency care and non-emergency services at in-network facilities. Finally, do not assume that being in-network guarantees the lowest price; always ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront, effectively bypassing the administrative costs and markup associated with insurance billing cycles.