Occupational therapy (therapeutic activities)
Facility: Stevens County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $72
- Cash Discount Price: $83
- vs. Medicare Baseline: 2.05x 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 205% of the Medicare baseline (a markup of 105%). 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 | $31 | 88% |
| Aetna | $32 - $83 | 91% |
| Blue Cross Blue Shield | $54 - $57 | 154% |
| First Health - All Plans | $74 | 211% |
| Wppa - All Plans | $79 | 225% |
| Medicaid / KanCare | $83 | 237% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Stevens County Hospital in Hugoton, Kansas, the cash price is $83.00, which matches the facility's negotiated rate for Medicaid and the gross charge. While the facility's cash rate is significantly higher than the state average of $72.00, patients with high-deductible plans may find paying cash directly more cost-effective than using insurance, as the insurance negotiated rate of $72.00 often exceeds the cash price for out-of-network scenarios. It is important to note that commercial payers like Aetna and Blue Cross Blue Shield have negotiated rates ranging from $31 to $83, meaning the actual out-of-pocket cost depends heavily on your specific plan's deductible status and allowed amount.
To minimize unexpected costs, patients should verify if the hospital offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50%. If you receive a bill after using insurance, ensure it is an itemized statement rather than a summary bill, as hospitals sometimes bundle charges to obscure individual costs. Additionally, if you are billed for services from an out-of-network provider at this in-network facility, the No Surprises Act may protect you from balance billing, so you should dispute any surprise charges with your insurer rather than paying immediately. Always request a formal written audit dispute if you believe errors exist, as over 80% of hospital bills contain mistakes that can be corrected.