Occupational therapy (therapeutic activities)
Facility: Cheyenne County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $77
- Cash Discount Price: $81
- vs. Medicare Baseline: 2.20x 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 220% of the Medicare baseline (a markup of 120%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $49 | 140% |
| First Health - All Plans | $57 | 163% |
| UnitedHealthcare | $58 - $230 | 165% |
| Healthy Blue Mcr Adv | $58 | 165% |
| Tricare | $58 | 165% |
| Aetna | $58 - $77 | 165% |
| Choice Care - All Plans | $59 | 168% |
| Firstguard - All Plans | $65 | 185% |
| Wppa - All Plans | $73 | 208% |
| Preferred Hc - All Plans | $77 | 220% |
| Cpm - All Plans | $77 | 220% |
| Unicare - All Plans | $79 | 225% |
| Integrated Hp - All Plans | $79 | 225% |
| Ppo Next - All Plans | $79 | 225% |
| Health Partners - All Plans | $79 | 225% |
| Midlands Choice - All Plans | $79 | 225% |
| Healthy Blue Mcaid - All Other Plans | $81 | 231% |
| Childrens Mercy - All Plans | $81 | 231% |
| Healthwave Mcaid - All Plans | $81 | 231% |
| Providers Care-All Plans | $122 | 348% |
Consumer Guidance & Cost Commentary
For CPT code 97530, Occupational therapy (therapeutic activities), the cash price at Cheyenne County Hospital in St. Francis, KS, is $81.00. This cash rate is notably higher than the facility's negotiated average of $77.00 and the median paid amount of $73.00 across 20 payers. While the gross charge is $81.00, the Medicare benchmark for this service is $35.07, indicating that commercial rates are significantly above the federal baseline. Patients with high-deductible plans may find the cash price more favorable than their insurance negotiated rate, which can sometimes exceed the cash price due to administrative markups. It is important to verify your specific plan's allowed amount before scheduling, as some insurers may negotiate higher rates than the facility's cash self-pay rate.
To ensure you are not overcharged, always request a full itemized bill before paying, as summary bills often obscure individual line items or unbundled charges. If you receive a balance bill for out-of-network services, remember that the No Surprises Act generally protects you from paying the difference between the provider's chargemaster and your insurance allowed amount for emergency care and non-emergency services at in-network facilities. Additionally, ask the hospital directly about prompt-pay discounts, which can reduce the final cost by 20% to 50% if you pay in full upfront, bypassing the costly insurance claims process. Since this facility is a Critical Access Hospital with a voluntary non-profit ownership, they may offer specific self-pay incentives that are not reflected in the standard negotiated rates.