Occupational therapy (therapeutic activities)
Facility: Goodland Regional Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $88
- Cash Discount Price: $88
- vs. Medicare Baseline: 2.51x 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 251% of the Medicare baseline (a markup of 151%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $49 | 140% |
| Wppa | $83 - $88 | 237% |
| UnitedHealthcare | $88 | 251% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (therapeutic activities) service at Goodland Regional Medical Center, the cash price of $88.00 is notably higher than the Medicare benchmark of $35.07, reflecting a markup of 2.5 times the federal baseline. While the facility's negotiated rates with major payers like Blue Cross Blue Shield and UnitedHealthcare range between $49 and $88, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying out-of-pocket. It is important to note that the median negotiated rate of $88.00 aligns with the cash median, suggesting that commercial contracts in this specific location do not offer a lower price than self-pay.
Before scheduling, patients should verify their deductible status and explicitly request a "self-pay" or "prompt-pay" discount, as hospitals frequently offer fee reductions for upfront payment to bypass administrative costs. Although the No Surprises Act protects against balance billing for emergency care and non-emergency services at in-network facilities, patients should still review their itemized bills to ensure no unbundled codes or services not rendered are included. Given that the facility is a Critical Access Hospital in Kansas, comparing these specific rates to local averages helps clarify whether the pricing is fair relative to the region's wage index and cost structure.