Occupational therapy (therapeutic activities)
Facility: Hodgeman County Health Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $69
- Cash Discount Price: $78
- vs. Medicare Baseline: 1.97x 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 |
|---|---|---|
| Blue Cross Blue Shield | $47 - $49 | 134% |
| Medicaid / KanCare | $63 - $98 | 180% |
| Humana | $63 | 180% |
| UnitedHealthcare | $63 - $93 | 180% |
| Triwest - All Plans | $63 | 180% |
| Aetna | $78 | 222% |
| First Health - All Plans | $88 | 251% |
| Health Partners - All Plans | $93 | 265% |
| Wppa (Provdrscare) - All Plans | $93 | 265% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service at Hodgeman County Health Center in Jetmore, Kansas, the cash median rate is $78.00, which is significantly lower than the facility's negotiated rates with major payers. While Medicaid/KanCare and Humana have a fixed negotiated rate of $63.00, other insurers like Blue Cross Blue Shield range from $47.00 to $49.00, and UnitedHealthcare ranges from $63.00 to $93.00. This variation highlights that in-network insurance coverage does not guarantee the lowest price; in some cases, paying cash directly may result in a lower out-of-pocket cost compared to the insurance negotiated amount, particularly for patients with high deductibles who might otherwise face higher bills.
When evaluating the cost against national standards, the facility's cash rate of $78.00 is 2.0 times the Medicare benchmark of $35.07, indicating a substantial markup relative to the federal government's fixed reimbursement rate. It is important to note that while the facility is a Critical Access Hospital with government-local ownership, patients should actively request an itemized bill to ensure no errors, double-billing, or unbundled codes are present, as over 80% of hospital bills contain mistakes. Additionally, patients should inquire about prompt-pay discounts before scheduling, as paying in full upfront can often reduce the total cost by 20% to 50%, bypassing the administrative overhead associated with insurance claims processing.