Occupational therapy (therapeutic activities)
Facility: Cloud County Health Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $106
- Cash Discount Price: $81
- vs. Medicare Baseline: 3.02x 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 302% of the Medicare baseline (a markup of 202%). 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 |
|---|---|---|
| Aetna | $84 - $135 | 240% |
| Mpi-All Plans | $89 - $138 | 254% |
| Health Partners - All Plans | $89 - $138 | 254% |
| Pponext-All Plans | $89 - $138 | 254% |
Consumer Guidance & Cost Commentary
For the CPT code 97530, representing occupational therapy services, Cloud County Health Center in Concordia, KS, has a cash median price of $81.00 and a median negotiated rate of $106.00. This cash price is notably lower than the facility's gross charge of $115.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that paying cash upfront can sometimes result in a lower out-of-pocket cost than using insurance, particularly if their plan has a high deductible. The data indicates a median paid amount of $106.00, which aligns with the median negotiated rate, suggesting that for many insured patients, the insurance payment matches the facility's contract rate.
When evaluating the cost relative to federal standards, the facility's gross charge of $115.00 is significantly higher than the Medicare amount of $35.07, reflecting a substantial markup common in commercial billing. However, the cash price of $81.00 remains well above the Medicare benchmark, illustrating that even cash payments at this facility exceed the federal cost baseline. It is important for consumers to request a prompt-pay discount before scheduling services, as hospitals often offer a fee reduction for upfront payment to bypass administrative claim processing costs. Additionally, patients should ensure they receive an itemized bill rather than a summary invoice to verify that all charges correspond to services actually rendered, as errors or unbundled codes can inflate the final amount owed.