Occupational therapy (therapeutic activities)
Facility: Overland Park Reg Med Ctr
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $67
- Cash Discount Price: $349
- vs. Medicare Baseline: 1.91x 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 |
|---|---|---|
| Amerigroup | $28 | 80% |
| United | $28 - $158 | 80% |
| Humana | $29 - $76 | 83% |
| Healthyblue | $29 | 83% |
| Medicaid / KanCare | $29 | 83% |
| Devoted Health | $29 - $33 | 83% |
| Blue Cross Blue Shield | $29 - $151 | 83% |
| Coventry | $29 - $141 | 83% |
| Celtic | $30 - $34 | 86% |
| Cigna | $30 - $34 | 86% |
| Wellcare | $30 - $34 | 86% |
| Unicare | $30 | 86% |
| Aetna | $30 - $179 | 86% |
| Pyramid Life | $31 - $35 | 88% |
| Home State Health Plan | $32 | 91% |
| Triwest Health Alliance | $33 | 94% |
| Multiplan | $44 - $260 | 125% |
| Corvel Corporation | $52 - $228 | 148% |
| Oha Network | $54 - $176 | 154% |
| Ambetter / Centene | $64 - $65 | 182% |
| Oscar | $66 - $67 | 188% |
| Nhc Advantage | $66 - $67 | 188% |
| Wppa Providrs Care Network | $69 - $70 | 197% |
| Universal Healthcare | $121 - $123 | 345% |
| Coventry Kc Mo | $142 - $144 | 405% |
| College Park Family Care Center | $149 - $151 | 425% |
| Cco, Inc. | $259 - $264 | 739% |
| Focus Healthcare Mgmt, Inc | $259 - $264 | 739% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service, the facility's cash price of $349.00 is significantly higher than the state average, which is approximately $70.00. While many commercial payers negotiate rates ranging from $28 to $179, these negotiated amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that the facility's cash rate is nearly double the Medicare benchmark of $35.07, indicating a substantial markup relative to the federal cost baseline. To potentially lower costs, patients should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
Although the facility offers a median negotiated rate of $67.00 across various payers, this figure represents the maximum allowed amount under contract and does not guarantee the lowest possible price for every member. Patients should be cautious of balance billing if their insurance does not fully cover the service, as the No Surprises Act protects against unexpected out-of-network charges at in-network facilities but does not eliminate the need to verify coverage limits. Furthermore, since over 80% of hospital bills contain errors, receiving a detailed, itemized statement is crucial to identifying unbundled codes or services not rendered. If a large bill arrives after insurance processing, patients should request a formal written audit dispute rather than paying immediately, ensuring that any discrepancies are corrected before final payment.