Occupational therapy (therapeutic activities)
Facility: St. Catherine Hospital - Garden City
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $131
- Cash Discount Price: $65
- vs. Medicare Baseline: 3.74x 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 374% of the Medicare baseline (a markup of 274%). 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 | $35 - $232 | 100% |
| Cigna | $36 - $202 | 103% |
| Aetna | $36 - $160 | 103% |
| Kansas Health | $36 | 103% |
| Devoted Health | $36 | 103% |
| Blue Cross Blue Shield | $36 - $205 | 103% |
| Medicare (plans) | $36 | 103% |
| Kaiser | $36 - $70 | 103% |
| Innovage | $36 | 103% |
| Humana | $36 | 103% |
| Denver Health | $60 | 171% |
| Direct To Employer | $69 - $107 | 197% |
| Centura Employee Plan | $72 | 205% |
| Peak Health | $99 - $100 | 282% |
| Wpaa | $112 - $115 | 319% |
| Christian Health Aid | $128 - $131 | 365% |
| Multiplan | $131 - $217 | 374% |
| United Colorado Doctor'S Plan | $143 - $150 | 408% |
| Health Partners Of Kansas | $155 - $159 | 442% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service (CPT 97530), St. Catherine Hospital - Garden City has a gross charge of $164.00, which is significantly higher than the state of Kansas average. The facility's cash median price of $65.00 is notably lower than the state average, making it a potentially cost-effective option for patients paying out-of-pocket. While the hospital's negotiated rates with major payers like UnitedHealthcare and Cigna range from $35 to over $200, these amounts are often inflated by administrative overhead and contract structures. Patients should be aware that commercial negotiated rates frequently exceed cash prices; therefore, if you have a high-deductible plan, paying the cash median of $65.00 upfront might result in lower out-of-pocket costs compared to your insurance's allowed amount, provided you have met your deductible.
To maximize savings, it is crucial to verify your specific plan's negotiated rate before scheduling, as in-network rates vary widely across different insurance carriers. For instance, while Medicare sets a benchmark of $35.07 for this service, commercial rates can average 200% to 300% of that amount, though fair pricing is typically defined as 120% to 150%. If you choose to pay directly, ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% when paid in full within a short window. Additionally, ensure you receive an itemized bill rather than a summary statement, as over 80% of hospital bills contain errors such as double