Occupational therapy (therapeutic activities)
Facility: University Of Ks Hlth System Great Bend Campus
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $80
- Cash Discount Price: $27
- vs. Medicare Baseline: 2.28x 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 228% of the Medicare baseline (a markup of 128%). 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 |
|---|---|---|
| Workers Comp [503999901] | $33 - $113 | 94% |
| Ku Athletics [503200094] | $33 | 94% |
| Medicare (plans) | $33 | 94% |
| Humana | $33 | 94% |
| UnitedHealthcare | $33 - $92 | 94% |
| Blue Cross Blue Shield | $34 | 97% |
| Allwell [503200078] | $34 | 97% |
| Centurion [5032000966] | $42 | 120% |
| Ambetter / Centene | $47 | 134% |
| Alt Wppa [5032000964] | $56 | 160% |
| Meritain Health [503200039] | $56 - $80 | 160% |
| Wppa [503200056] | $56 | 160% |
| Alt Carelon Behavioral Health [503200905] | $66 | 188% |
| Php [503200005] | $80 | 228% |
| Aha-Healthcare Preferred [503200050] | $80 | 228% |
| Cigna | $80 - $106 | 228% |
| Aetna | $80 | 228% |
| First Health [5032000110] | $80 | 228% |
| Alt Meritain Health [503999911] | $80 | 228% |
| National Assn Letter Carriers [503200019] | $80 | 228% |
| Allied National [503999937] | $80 | 228% |
| 6 Degrees Health [503999050] | $81 | 231% |
| Fort Hays State Student Athletes [5032000960] | $90 | 257% |
| Occunet [503999930] | $90 | 257% |
| Medica [503200074] | $92 | 262% |
| Geha [503200036] | $92 | 262% |
| Correct Care Solutions [50311253] | $93 | 265% |
| Advanced Medical Pricing Solutions [503301513] | $98 | 279% |
| Usa Managed Care [503999030] | $120 | 342% |
| Hchsync Centrus Health Direct [503999916] | $130 - $150 | 371% |
Consumer Guidance & Cost Commentary
This CPT code for occupational therapy therapeutic activities has a gross charge of $133.00, which is significantly higher than the facility's cash median of $27.00. While the facility's negotiated rates with insurance payers range from $33 to $150, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying cash directly. It is important to note that commercial negotiated rates frequently include administrative overhead and can be 200% to 300% of the Medicare benchmark rate of $35.07, whereas fair pricing is typically defined as 120% to 150% of this federal baseline.
Patients should verify their specific plan details before scheduling, as assuming in-network status guarantees the lowest price is a common pitfall; some in-network facilities charge substantially more than others. If you receive a bill, always request a full itemized CPT-coded statement rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, if you are out-of-network, the No Surprises Act generally protects you from balance billing for emergency care and non-emergency services at in-network facilities, but you should still dispute any unexpected charges in writing to avoid credit damage. Finally, ask the hospital about prompt-pay discounts before check-in, as paying upfront can bypass costly claims processing and reduce your total bill by 20% to 50%.