Occupational therapy (therapeutic activities)
Facility: Clara Barton Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $73
- Cash Discount Price: $64
- vs. Medicare Baseline: 2.08x 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 208% of the Medicare baseline (a markup of 108%). 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 | 140% |
| 6 Degrees Health - All Plans | $57 - $71 | 163% |
| Wppa-All Plans | $65 - $81 | 185% |
| Aetna | $73 - $91 | 208% |
| Phcs - All Plans | $73 - $91 | 208% |
| UnitedHealthcare | $73 - $91 | 208% |
| Hlth Partners Of Ks-All Plans | $75 - $93 | 214% |
Consumer Guidance & Cost Commentary
For CPT code 97530, representing occupational therapy therapeutic activities at Clara Barton Hospital in Hoisington, KS, the facility's cash median rate is $64.00, which is lower than the state average of $74.00. While commercial payers negotiate rates ranging from $49 to $93 depending on the plan, patients with high-deductible plans may find paying the cash price directly more cost-effective if their insurance negotiated rate exceeds $64.00. Because commercial rates often include administrative overhead and markup, the cash option can bypass these layers, but patients should verify with the hospital for specific "self-pay" or "prompt-pay" discounts that could further reduce the final amount owed.
It is important to note that Medicare sets a benchmark of $35.07 for this service, which serves as a baseline for evaluating fair pricing; commercial rates are significantly higher than this federal standard. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still request a detailed, itemized bill to ensure no unbundled codes or services not rendered are included. If a discrepancy arises, consumers should dispute the bill in writing rather than accepting summary invoices, as over 80% of hospital bills contain errors that can be corrected through a formal audit.