Occupational therapy (therapeutic activities)
Facility: Hamilton County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $92
- Cash Discount Price: $102
- vs. Medicare Baseline: 2.62x 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 262% of the Medicare baseline (a markup of 162%). 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 | $23 - $57 | 66% |
| First Health Coventry - All Plans | $87 | 248% |
| UnitedHealthcare | $97 | 277% |
| Cigna | $97 | 277% |
| Va Ccn - All Plans | $102 | 291% |
| Aetna | $173 | 493% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service at Hamilton County Hospital in Syracuse, KS, the cash price is $102.00, which matches the facility's negotiated rate and the median paid amount. This cash price is significantly lower than the Medicare benchmark of $35.07, indicating a markup of 2.6 times the federal rate. While the facility is a Critical Access Hospital with government-local ownership, patients should be aware that commercial insurance plans often negotiate rates higher than cash prices; for instance, Aetna's negotiated rate is $173.00, and First Health Coventry's is $87.00. Because commercial contracts can exceed cash rates, paying out-of-pocket may result in lower out-of-pocket costs for patients with high-deductible plans, provided they qualify for the cash price.
To ensure you receive the most accurate pricing, it is recommended to request an itemized billing audit before finalizing payment, as summary bills often obscure individual code costs and potential errors. If you choose to use insurance, verify your deductible status, as many plans will not cover services until that threshold is met, potentially leaving you responsible for the full negotiated amount. Additionally, ask the billing department about prompt-pay discounts, which can reduce the total cost by 20% to 50% if paid upfront, effectively bypassing administrative fees and insurance processing delays. Always confirm whether your specific plan is in-network, as out-of-network care could trigger balance billing for the difference between the allowed amount and the full chargemaster rate, even at this facility.