Occupational therapy (therapeutic activities)
Facility: Kearny County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $95
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 2.71x 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 271% of the Medicare baseline (a markup of 171%). 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 |
|---|---|---|
| Wps Gha - Mac J5 Part A | $95 - $285 | 271% |
| UnitedHealthcare | $95 | 271% |
| Blue Cross Blue Shield | $95 - $380 | 271% |
| Kansas Solutions | $95 | 271% |
| Community Care Health Plan Of | $190 | 542% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Kearny County Hospital in Lakin, KS, the commercial negotiated rates range from $95 to $380, with a median of $95 across five payers. These rates are significantly higher than the Medicare benchmark of $35.07, reflecting the typical markup found in commercial contracts where administrative costs and network tiering drive prices well above the federal baseline. While the facility is a Critical Access Hospital owned by the local government, the negotiated amounts do not align with the state or county averages, which often sit closer to the Medicare benchmark when adjusted for local wage indexes. Patients should be aware that assuming an in-network rate is the lowest possible price can be misleading, as some commercial contracts may exceed the facility's cash price.
If you have a high-deductible plan, paying cash might be more cost-effective than using insurance, particularly since the cash price is not listed but the negotiated rates exceed the Medicare benchmark. We recommend contacting the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% for upfront payment. Additionally, before scheduling, verify your deductible status to avoid unexpected out-of-pocket costs, and ensure you sign a waiver of insurance submission if you choose to pay cash to prevent the hospital from submitting a claim that could void your discount. Always request a full itemized bill before paying to identify any errors or unbundled codes, as over 80% of hospital bills contain discrepancies that can be resolved through a formal audit.