Occupational therapy (therapeutic activities)
Facility: Sheridan County Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $78
- Cash Discount Price: $98
- vs. Medicare Baseline: 2.22x 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 222% of the Medicare baseline (a markup of 122%). 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 |
|---|---|---|
| Celtic Insurance | $59 | 168% |
| Blue Cross Blue Shield | $78 | 222% |
| UnitedHealthcare | $93 | 265% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Sheridan County Hospital in Hoxie, KS, the cash price is $98.00, which matches the facility's median negotiated rate of $78.00 for in-network plans. While the facility is a Critical Access Hospital owned by the local government, the cash price is notably higher than the state average of $35.07, which is based on Medicare reimbursement rates. This significant markup suggests that for patients with high-deductible plans or those without insurance, paying cash directly might be more cost-effective than relying on insurance, as the negotiated rate often includes administrative overhead that inflates the final bill.
Patients should be aware that commercial insurance carriers typically pay negotiated rates that can exceed the cash price due to complex billing structures and administrative costs. If you are self-pay, it is advisable to ask the hospital about "prompt-pay" discounts, which can reduce the total amount owed by 20% to 50% if you settle the bill upfront. Additionally, since the facility is in-network, the No Surprises Act likely protects you from balance billing for emergency care or non-emergency services from out-of-network providers at this location, though you should still request an itemized bill to verify that all charges are accurate and that no unbundled codes or services not rendered have been included.