Occupational therapy (therapeutic activities)
Facility: St Luke Hospital & Living Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $27
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.77x 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 |
|---|---|---|
| Bluestem Pace | $26 - $29 | 74% |
| Ambetter / Centene | $26 - $29 | 74% |
| Blue Cross Blue Shield | $26 - $29 | 74% |
| Va Ccn | $26 - $29 | 74% |
| Humana | $26 - $29 | 74% |
| UnitedHealthcare | $26 - $29 | 74% |
| Kansas Department Of Health And Environment | $26 - $29 | 74% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service at St Luke Hospital & Living Center in Marion, KS, the facility's cash and negotiated rates are significantly lower than the state average. While the facility's cash median is not available, the negotiated rate of $27.00 is notably below the state average of $29.00. This pricing structure aligns with the facility's status as a Critical Access Hospital, which often operates under specific federal cost benchmarks that can result in lower reimbursement rates compared to larger urban centers.
When comparing this service to Medicare, the facility's rates are 80% of the Medicare benchmark amount of $35.07, indicating a pricing model that is below the federal baseline. For patients with high-deductible plans, paying the cash price directly could be more cost-effective than relying on insurance, as commercial negotiated rates often include administrative overhead that pushes them above the true cost of care. It is recommended to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can further reduce the final amount owed by bypassing the standard insurance billing cycle.