Occupational therapy (therapeutic activities)
Facility: Stafford County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $75
- Cash Discount Price: $75
- vs. Medicare Baseline: 2.14x 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 214% of the Medicare baseline (a markup of 114%). 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 |
|---|---|---|
| Health Partners-All Plans | $66 - $74 | 188% |
| Medica Mcr- All Plans | $70 - $78 | 200% |
| UnitedHealthcare | $70 - $78 | 200% |
| Humana | $70 - $78 | 200% |
| Va Ccn-All Plans | $70 - $78 | 200% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service (CPT 97530) at Stafford County Hospital, the cash and negotiated rates are identical at $75.00, which matches the median paid across all five payers listed. This rate is significantly higher than the Medicare benchmark of $35.07, reflecting a markup of 210% over the federal baseline. While the facility is a Critical Access Hospital in Stafford, KS, the data provided does not include specific county or state average comparisons for this service code, so no regional pricing context can be established from this report.
Given that the cash price equals the negotiated rate, patients with high-deductible plans may find paying out-of-pocket directly more cost-effective than using insurance, as the insurer would likely cover only the Medicare-approved amount of $35.07, leaving the patient responsible for the remaining balance. To minimize costs, patients should inquire about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the total bill by 20% to 50%. Additionally, since the facility is government-owned, patients should request a full itemized bill to verify that no unbundled charges or services not rendered are included, ensuring the final amount aligns with the $75.00 rate or any applicable discounts.