Occupational therapy (therapeutic activities)
Facility: Holton Community Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $66
- Cash Discount Price: $59
- vs. Medicare Baseline: 1.88x 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 |
|---|---|---|
| UnitedHealthcare | $42 - $100 | 120% |
| Aetna | $42 - $79 | 120% |
| Humana | $42 | 120% |
| Kansas Superior Select - All Plans | $43 | 123% |
| Blue Cross Blue Shield | $49 | 140% |
| Preferred Health Fn Select - All Other Plans | $66 | 188% |
| Preferred Health Professionals | $66 | 188% |
| Preferred Health Freedom | $66 | 188% |
| Wppa Providers - All Plans | $75 | 214% |
| Medicaid / KanCare | $79 | 225% |
Consumer Guidance & Cost Commentary
For this Occupational therapy service at Holton Community Hospital, the negotiated rates range from $42 to $79 depending on your specific insurance plan, with the lowest allowed amount being $42. This facility is a Critical Access Hospital in Kansas, and while the median negotiated rate of $66 aligns with the state average, the cash price of $59 is notably lower than the negotiated amounts. For patients with high-deductible plans, paying the cash price of $59 upfront may be more cost-effective than relying on insurance, as the insurer's negotiated rate often exceeds the cash price due to administrative overhead and contract structures. We recommend verifying your specific plan's allowed amount before scheduling and asking the hospital directly about "self-pay" or "prompt-pay" discounts, which can further reduce the final cost.
The Medicare benchmark for this procedure is $35.07, which serves as a reliable baseline for evaluating pricing fairness. Commercial negotiated rates at this facility average 1.9 times the Medicare amount, reflecting standard market dynamics where commercial rates include additional administrative costs and profit margins. To ensure you are not overcharged, we suggest requesting an itemized billing audit if you receive a summary bill, as these often hide unbundled codes or services not rendered. Additionally, under the No Surprises Act, you are protected from balance billing for out-of-network services at in-network facilities, so you should never feel pressured to pay a surprise difference without first disputing the claim with your insurer.