Occupational therapy (therapeutic activities)
Facility: Lindsborg Community Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $84
- Cash Discount Price: $68
- vs. Medicare Baseline: 2.40x 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 240% of the Medicare baseline (a markup of 140%). 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 |
|---|---|---|
| Coventry Mcr Adv | $31 - $69 | 88% |
| Tricare | $31 - $68 | 88% |
| Blue Cross Blue Shield | $49 | 140% |
| Cigna | $55 - $123 | 157% |
| UnitedHealthcare | $58 - $131 | 165% |
| Coventry Comm-All Other Plans | $58 - $131 | 165% |
| Phcs Preferred-All Plans | $60 - $135 | 171% |
| Multiplan-All Plans | $60 - $135 | 171% |
| Coventry Wc | $62 - $138 | 177% |
| Century Health-All Plans | $62 - $138 | 177% |
| Health Partners -All Plans | $62 - $138 | 177% |
| Wppa-All Plans | $62 - $138 | 177% |
Consumer Guidance & Cost Commentary
For the CPT code 97530, Occupational therapy (therapeutic activities), Lindsborg Community Hospital in Lindsborg, KS, lists a cash median price of $68.00 and a median negotiated rate of $84.00. This cash price is notably lower than the facility's Medicare benchmark of $35.07, with the cash rate representing a 2.4x markup relative to the federal baseline. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial payers negotiate rates ranging from $31 to $138 depending on the specific plan, with some carriers like Coventry Mcr Adv and Tricare offering the lowest negotiated amounts at $31. Because insurance negotiated rates often exceed cash prices due to administrative overhead and contract dynamics, individuals with high-deductible plans may find paying the cash rate directly more cost-effective than relying on in-network insurance coverage.
To ensure you receive the most accurate pricing, it is essential to request an itemized billing audit before finalizing payment, as summary bills can obscure individual charges and potential errors. If you choose to pay out-of-pocket, ask the hospital specifically about "self-pay" or "prompt-pay" discounts, which can reduce the total amount owed by 20% to 50% when paid in full upfront. Additionally, while the No Surprises Act protects patients from balance billing for emergency care at in-network facilities, it is prudent to verify your deductible status before scheduling services to avoid unexpected out-of-pocket costs. Always confirm the exact allowed amount with the billing department, as commercial rates vary significantly across the 12 payers listed for this service