Occupational therapy (therapeutic activities)
Facility: Stanton County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $110
- Cash Discount Price: $116
- vs. Medicare Baseline: 3.14x 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 314% of the Medicare baseline (a markup of 214%). 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 | $54 - $110 | 154% |
| Healthy Blue Mcr Adv - All Other Plans | $113 | 322% |
| Healthy Blue Mcaid | $116 | 331% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Stanton County Hospital in Johnson, KS, the cash price is $116.00, which matches the facility's negotiated rate with Healthy Blue Mcaid and the gross charge. This cash price is significantly higher than the state average of $111.00, representing a 3.1% increase over the typical state rate. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that cash payments can sometimes be more cost-effective than using insurance if the patient's deductible has not yet been met, as the negotiated rate for some payers like Blue Cross Blue Shield ranges from $54 to $110, but the actual allowed amount varies by plan.
To ensure you are receiving the best possible rate, it is highly recommended to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, you should explicitly ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if paid upfront, bypassing the administrative overhead associated with insurance claims. When comparing prices, always verify the specific allowed amount for your insurance plan rather than relying on the hospital's gross chargemaster list, as commercial negotiated rates often include administrative markups that do not reflect the true cost of care.