Occupational therapy (therapeutic activities)
Facility: University Of Kansas Health System - St Francis Campus
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $70
- Cash Discount Price: $51
- vs. Medicare Baseline: 2.00x 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 |
|---|---|---|
| Black Lung [6055] | $70 | 200% |
| Oncology Patient Assistance Programs [2295] | $70 | 200% |
| Blue Cross Blue Shield | $70 | 200% |
| Aetna | $70 | 200% |
| Healthcare Highways [2210] | $70 | 200% |
| Lucent Health [6000] | $70 | 200% |
| Web Tpa [2115] | $70 | 200% |
| Hooray Health [8000] | $70 | 200% |
| Department Of Corrections [1340] | $86 | 245% |
| National Association Of Letter Carriers [1695] | $99 | 282% |
| Healthpartners [1500] | $99 | 282% |
| American Postal Workers Union [1070] | $99 | 282% |
| Cigna | $99 | 282% |
| Humana | $101 | 288% |
| Administrative Concepts [1005] | $133 | 379% |
| Multiplan [1680] | $133 | 379% |
| American Healthcare [1055] | $133 | 379% |
| First Health [1375] | $133 | 379% |
| Coventry Healthcare [1320] | $140 | 399% |
| Ks Disability Determination [6090] | $171 | 488% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service (CPT 97530), the University Of Kansas Health System - St Francis Campus in Topeka, KS, has a gross charge of $171.00. While the facility's negotiated rates with insurance payers range from $70.00 to $133.00, the cash-pay median is significantly lower at $51.00. This price transparency data highlights that for patients with high-deductible plans, paying cash directly can sometimes be more cost-effective than relying on insurance, as the facility's negotiated rates often exceed the cash price. To maximize savings, patients should verify their specific plan's allowed amount and inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill.
It is important to understand that commercial insurance rates are often inflated by administrative costs and contract dynamics, with negotiated rates frequently sitting well above the Medicare benchmark of $35.07 for this procedure. The facility's cash rate of $51.00 is notably higher than the Medicare amount, illustrating that Medicare rates serve as a baseline for "true cost" rather than a reflection of commercial pricing. Patients should be cautious of balance billing if they are out-of-network, as the No Surprises Act protects against surprise bills for emergency care and non-emergency services at in-network facilities. If a patient receives a bill exceeding the negotiated or cash rates, they should request a formal itemized audit to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies that can be corrected through written dispute.