Occupational therapy (therapeutic activities)
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $33
- Cash Discount Price: $38
- vs. Medicare Baseline: 0.94x 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 |
|---|---|---|
| Medicaid / KanCare | $27 - $30 | 77% |
| UnitedHealthcare | $28 - $91 | 80% |
| Aetna | $30 | 86% |
| Humana | $33 | 94% |
| Va | $33 | 94% |
| Medicare (plans) | $33 | 94% |
| Smarthealth | $46 | 131% |
| Providrs Care | $46 | 131% |
| Ambetter / Centene | $55 | 157% |
| Blue Cross Blue Shield | $62 - $65 | 177% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service, the facility's cash median rate of $38.00 is significantly lower than the negotiated rates charged to most insurance plans, which range from $27 to $65 depending on the carrier. While the facility's negotiated rate of $33.00 is lower than its gross charge of $96.00, it remains higher than the cash price, meaning patients with high-deductible plans or those without insurance may save money by paying cash directly. It is important to note that while the facility is an in-network Acute Care Hospital in Manhattan, KS, patients should verify their specific plan's deductible status before relying on insurance, as some plans may still require out-of-pocket payments before coverage kicks in. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as paying in full upfront can sometimes bypass the administrative costs associated with insurance claims processing.
When evaluating the cost of this service, it is more accurate to compare rates against the Medicare benchmark rather than the facility's inflated chargemaster list. The Medicare amount for this code is $35.07, which serves as a scientifically validated baseline for the true cost of delivery. Although the facility's cash rate of $38.00 is slightly higher than the Medicare amount, it is substantially lower than the gross charge of $96.00, indicating a significant discount from the list price. Commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40% compared to the Medicare rate. If a patient receives a bill that includes unexpected charges beyond the negotiated amount, they