Occupational therapy (therapeutic activities)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $64
- Cash Discount Price: $67
- vs. Medicare Baseline: 1.82x 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 |
|---|---|---|
| Tricare | $54 | 154% |
| Humana | $61 | 174% |
| Aetna | $62 - $67 | 177% |
| UnitedHealthcare | $64 | 182% |
| Hpk-All Plans | $64 | 182% |
| Medicaid / KanCare | $67 | 191% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price of $67.00 is identical to the facility's median negotiated rate of $64.00 and the cash median reported for the region. While commercial payers like Aetna and UnitedHealthcare have negotiated rates ranging from $61 to $67, these amounts are generally higher than the cash price, which can be a significant factor for patients with high-deductible plans. Because insurance contracts often include administrative overhead and multi-layered billing structures, the cash price here represents a direct, lower-cost option compared to the standard negotiated rates. Patients should verify their specific plan details, as paying out-of-pocket may result in lower out-of-pocket costs than the insurance allowed amount, provided they have met their deductible.
To ensure you are not overcharged, it is important to understand that hospitals often issue summary bills that obscure individual line items, making it difficult to spot errors or unbundled charges. Before signing any consent forms or paying a final invoice, request a full itemized bill that lists every CPT code and service rendered to identify any discrepancies or services not received. Additionally, if you are receiving care from an out-of-network provider at this facility, be aware that the No Surprises Act protects you from balance billing for emergency and non-emergency services, meaning you should not pay the difference between the provider's full charge and your insurance payment without first disputing the bill with your insurer. Finally, ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if you settle the account in