Occupational therapy (therapeutic activities)
Facility: Saint Luke'S South Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $90
- Cash Discount Price: $176
- vs. Medicare Baseline: 2.57x 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 257% of the Medicare baseline (a markup of 157%). 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 |
|---|---|---|
| Aetna | $23 - $278 | 66% |
| Medicaid / KanCare | $28 - $45 | 80% |
| Transplants-Case Rates [5750] | $32 - $293 | 91% |
| UnitedHealthcare | $38 - $127 | 108% |
| Blue Cross Blue Shield | $47 - $90 | 134% |
| Humana | $64 - $94 | 182% |
| Cigna | $80 - $289 | 228% |
| First Health [5512] | $174 | 496% |
| Commercial-Contracted [8000] | $203 - $237 | 579% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service at Saint Luke's South Hospital in Overland Park, KS, the cash median price is $176.00, which is significantly lower than the facility's negotiated rates with major payers like Aetna ($23–$278) and Cigna ($80–$289). While the facility's cash rate is higher than the state-wide average for this procedure, it remains a substantial discount compared to the gross chargemaster of $293.00. Patients with high-deductible plans may find the cash price more affordable than their insurance negotiated rate, as the commercial contracts often include administrative overhead that inflates the baseline price by 20% to 40%. To maximize savings, we recommend requesting a "self-pay" or "prompt-pay" discount directly from the hospital before scheduling, as these upfront payment incentives can reduce the total cost by an additional 20% to 50%.
When reviewing your final invoice, it is critical to avoid accepting summary bills that obscure individual line items, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Always demand a full itemized CPT-coded statement to identify any double-billing or charges for supplies that were never delivered. Additionally, this service's Medicare benchmark is $35.07, and the facility's negotiated average of $90.00 represents a markup of approximately 2.6 times the Medicare rate. Since fair pricing is typically defined as 120% to 150% of the Medicare amount, the commercial rates charged by this facility exceed the standard benchmark, highlighting