Occupational therapy (therapeutic activities)
Facility: Kansas Medical Center Llc
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $33
- Cash Discount Price: $45
- vs. Medicare Baseline: 0.94x 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.
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 |
|---|---|---|
| Medicaid / KanCare | $28 | 80% |
| Tricare | $29 | 83% |
| Indian Health | $30 | 86% |
| Wppa | $30 | 86% |
| Humana | $33 | 94% |
| Ambetter / Centene | $33 | 94% |
| Blue Cross Blue Shield | $33 - $54 | 94% |
| Medadv_Wellcare | $33 | 94% |
| Three_Rivers | $66 | 188% |
| Aetna | $67 | 191% |
| United | $75 | 214% |
Consumer Guidance & Cost Commentary
For the CPT code 97530, representing occupational therapy therapeutic activities, Kansas Medical Center Llc in Andover, KS, lists a cash median price of $45.00, which is lower than the facility's negotiated rates of $33.00 to $75.00 across various payers. While the facility's cash rate is competitive, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. If you have a high-deductible plan, paying the cash price of $45.00 upfront might result in lower out-of-pocket costs compared to your insurance's allowed amount, especially if your deductible has not yet been met. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these can further reduce the final amount owed.
The facility's pricing for this service aligns closely with the Medicare benchmark of $35.07, with a vs_medicare ratio of 0.9, indicating that the cash rate is slightly below the federal baseline. This comparison highlights that the facility's pricing is grounded in cost-based standards rather than inflated chargemaster lists. However, commercial payers show a wide range of negotiated amounts, with Blue Cross Blue Shield plans ranging from $30 to $54 and Aetna at $67, demonstrating significant variation in in-network pricing. To avoid unexpected costs, patients should request an itemized bill before payment to verify that all charges are accurate and to identify any unbundled codes or services not rendered, ensuring the final invoice reflects the true cost of care.