Occupational therapy (therapeutic activities)
Facility: Graham County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $48
- Cash Discount Price: $64
- vs. Medicare Baseline: 1.37x 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 |
|---|---|---|
| Medicare (plans) | $38 - $58 | 108% |
| UnitedHealthcare | $40 - $74 | 114% |
| Celtic Commercial-All Other Plans | $41 - $64 | 117% |
| Medicaid / KanCare | $46 | 131% |
| Wppa (Providers Care)-All Plans | $48 - $74 | 137% |
| Blue Cross Blue Shield | $49 | 140% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Graham County Hospital in Hill City, KS, the cash price is $64.00, which matches the facility's cash median. While commercial payers like UnitedHealthcare and Wppa negotiate rates ranging from $40 to $74, the cash rate remains the lowest option available in this dataset. It is important to note that for patients with high-deductible plans, paying the full cash price of $64.00 upfront can sometimes be more cost-effective than relying on insurance, as the negotiated rates paid by insurers often exceed the cash price due to administrative overhead and contract structures. Patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can reduce the final bill by 20% to 50%.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the hospital's inflated chargemaster list. The Medicare allowed amount for this code is $35.07, which serves as the objective baseline for fair pricing. Commercial negotiated rates typically average 200% to 300% of this Medicare rate, whereas fair market value is generally considered to be between 120% and 150% of the Medicare amount. Since the facility is a Critical Access Hospital with government-local ownership, the negotiated rates reflect the specific contract dynamics of the region. Consumers should avoid accepting summary bills that obscure individual charges and instead request a detailed, itemized statement to ensure no errors or unbundled codes are included in the final invoice.