Occupational therapy (therapeutic activities)
Facility: Kansas City Orthopaedic Institute
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $103
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.94x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 294% of the Medicare baseline (a markup of 194%). 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 |
|---|---|---|
| Cigna | $45 - $125 | 128% |
| UnitedHealthcare | $47 - $124 | 134% |
| Aetna | $47 | 134% |
| Blue Cross Blue Shield | $80 - $117 | 228% |
| Medica | $172 | 490% |
Consumer Guidance & Cost Commentary
For CPT code 97530, representing occupational therapy therapeutic activities, the Kansas City Orthopaedic Institute in Leawood, KS, has a gross charge of $129.00. While the facility is owned by a physician and operates as an acute care hospital, the data does not provide specific cash or negotiated rates for this service. However, the facility's Medicare benchmark rate is $35.07, which serves as a critical baseline for evaluating pricing fairness. When comparing this to the broader market, the facility's gross charge is 2.9 times the Medicare amount, indicating a significant markup relative to the federal government's cost-based reimbursement standard.
Insurance coverage varies widely across the five payers listed, with allowed amounts ranging from $45 to $172 depending on the plan. For instance, Aetna has a single plan allowing exactly $47, while Blue Cross Blue Shield allows between $80 and $117 across eight plans. Because commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures, patients with high-deductible plans may find paying out-of-pocket cheaper if the insurance allowed amount is higher than the facility's self-pay rate. It is essential to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if settled upfront, and to request an itemized audit to ensure no errors or unbundled charges are included in the final invoice.