Occupational therapy (therapeutic activities)
Facility: Kiowa District Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $102
- Cash Discount Price: $86
- vs. Medicare Baseline: 2.91x 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 291% of the Medicare baseline (a markup of 191%). 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 |
|---|---|---|
| Tricare | $42 | 120% |
| Blue Cross Blue Shield | $49 | 140% |
| Healthchoice-All Plans | $58 | 165% |
| UnitedHealthcare | $86 - $108 | 245% |
| Health Partners Of Ks-All Plans | $95 | 271% |
| Humana | $97 | 277% |
| Multiplan-All Plans | $102 | 291% |
| Gbs Insurance - All Plans | $102 | 291% |
| Medicare (plans) | $103 | 294% |
| Aetna | $103 | 294% |
| Triwest-All Plans | $103 | 294% |
| Medicaid / KanCare | $108 | 308% |
| Providers Care (Wppa)-All Plans | $162 | 462% |
| Liberty Healthshare-All Plans | $174 | 496% |
Consumer Guidance & Cost Commentary
For CPT code 97530, Occupational therapy (therapeutic activities), the facility's cash median rate is $86.00, which is lower than the negotiated rates paid by most insurance plans listed. While the gross charge is $108.00, patients with high-deductible plans or those without insurance may find the cash price more affordable than the $102.00 median negotiated rate paid by insurers like UnitedHealthcare and Aetna. Because commercial contracts often include administrative overhead and multi-layered pricing structures, the cash rate can sometimes represent a better value for self-pay patients. It is important to verify if the facility offers "self-pay" or "prompt-pay" discounts, which can further reduce the final amount owed before services are rendered.
This service is provided at Kiowa District Hospital, a Critical Access Hospital in Kiowa, Kansas, with a facility ownership structure that is a Government Hospital District or Authority. The data reflects a vintage of 2026-06 and indicates that while the facility's cash rate is competitive, the negotiated rates vary significantly across the 14 payers represented, ranging from $42.00 for Tricare up to $174.00 for Providers Care. Patients should be aware that Medicare's benchmark rate for this code is $35.07, which serves as a baseline for evaluating the markup on commercial rates. To avoid unexpected costs, consumers should request an itemized bill to review specific CPT codes and ensure no services were unbundled or double-billed, as over 80% of hospital bills contain errors that can be corrected through a formal audit dispute.