Occupational therapy (therapeutic activities)
Facility: Kiowa County Memorial Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $80
- Cash Discount Price: $77
- vs. Medicare Baseline: 2.28x 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 228% of the Medicare baseline (a markup of 128%). 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 | $49 - $80 | 140% |
| UnitedHealthcare | $72 - $90 | 205% |
| Health Partners Of Ks-All Plans | $79 | 225% |
| Medica Prime Mcare Cost-All Plans | $80 | 228% |
| Aetna | $80 | 228% |
| Celtic Comml Exchange-All Other Plans | $80 | 228% |
| Humana | $80 | 228% |
| Medicaid / KanCare | $90 | 257% |
| Providrs Care/Wppa-All Plans | $135 | 385% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Kiowa County Memorial Hospital in Greensburg, KS, the facility's cash median rate of $77.00 is lower than the negotiated rates paid by most commercial payers, which range from $72.00 to $135.00 depending on the insurance plan. While the facility is a Critical Access Hospital with government local ownership, patients should be aware that commercial negotiated rates often exceed cash prices due to administrative overhead and contract structures. In cases where a patient has a high deductible or limited insurance coverage, paying the cash price of $77.00 may result in lower out-of-pocket costs compared to the insurance negotiated rate, provided the patient's plan allows for such payments. It is always advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these can further reduce the final amount owed.
When evaluating the value of this service, it is important to compare the facility's rates against the Medicare benchmark, which serves as the objective baseline for healthcare costs. The Medicare amount for this code is $35.07, and the facility's cash rate of $77.00 represents a markup of 2.3 times the Medicare rate. While commercial negotiated rates typically average between 200% and 300% of the Medicare rate, fair pricing is generally considered to be between 120% and 150% of the Medicare amount. Patients should avoid comparing their potential savings to the hospital's gross charge list, as these figures are inflated and do not reflect the true cost of care. Instead, understanding the relationship between the Medicare rate and the