Occupational therapy (therapeutic activities)
Facility: Logan County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $81
- Cash Discount Price: $22
- vs. Medicare Baseline: 2.31x 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 231% of the Medicare baseline (a markup of 131%). 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 |
|---|---|---|
| Humana | $47 | 134% |
| Blue Cross Blue Shield | $57 | 163% |
| Health Partners - All Plans | $104 | 297% |
| Medicaid / KanCare | $110 | 314% |
Consumer Guidance & Cost Commentary
For this Occupational therapy service at Logan County Hospital in Oakley, KS, the negotiated rates for major payers range from $47 to $110, while the cash-pay median is $22.00. This cash price is significantly lower than the facility's negotiated rates and the state average, making it a potentially more affordable option for patients with high-deductible plans or those without insurance. Because commercial insurance contracts often include administrative overhead that inflates the baseline price, paying out-of-pocket can sometimes result in substantial savings compared to the allowed amounts billed by insurers like Humana or Blue Cross Blue Shield.
To ensure you receive the best possible rate, we recommend asking the hospital directly about "self-pay" or "prompt-pay" discounts before scheduling your visit, as these upfront fee reductions can further lower the cost. If you do choose to use insurance, be aware that balance billing could occur if you receive care from out-of-network providers, though the No Surprises Act protects you from such unexpected charges for emergency services and non-emergency care at in-network facilities. Always request a full itemized bill before paying to verify that all charges are accurate and that no unbundled codes or services not rendered have been included.