Occupational therapy (therapeutic activities)
Facility: Jewell County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $97
- Cash Discount Price: $77
- vs. Medicare Baseline: 2.77x 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 277% of the Medicare baseline (a markup of 177%). 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 |
|---|---|---|
| Rural Carriers - All Plans | $87 | 248% |
| Meritain - All Plans | $92 | 262% |
| Aetna | $92 | 262% |
| UnitedHealthcare | $97 | 277% |
| Midlands Choice - All Plans | $97 | 277% |
| Cigna | $97 | 277% |
| First Health - All Plans | $97 | 277% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service at Jewell County Hospital, the cash price of $77.00 is significantly lower than the negotiated rates paid by insurance carriers, which average $97.00. This price difference highlights a common billing dynamic where commercial contracts often exceed cash prices due to administrative overhead and claim processing costs. While the facility's cash rate is notably lower than the state average of $97.00, patients with high-deductible plans may find it financially advantageous to pay the cash price directly, as the insurance negotiated rate of $97.00 could result in higher out-of-pocket expenses if the patient has not yet met their deductible.
To ensure you are receiving the most accurate and transparent pricing, it is essential to request an itemized bill that breaks down every specific code and charge, as summary bills often obscure individual costs. Additionally, you should verify if the facility offers a prompt-pay discount for upfront payment, which can further reduce the total amount owed. Since this facility is a Critical Access Hospital in Kansas, you may also want to compare the local negotiated rate against the broader state average to confirm you are receiving fair market value. Always confirm the exact self-pay or prompt-pay rates directly with the hospital before scheduling your visit to avoid unexpected billing surprises.