Occupational therapy (therapeutic activities)
Facility: Girard Medical Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $41
- Cash Discount Price: $71
- vs. Medicare Baseline: 1.17x 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 |
|---|---|---|
| Aetna | $41 - $206 | 117% |
| Medicare (plans) | $41 | 117% |
| UnitedHealthcare | $41 - $112 | 117% |
| Ambetter / Centene | $41 | 117% |
| Humana | $41 | 117% |
| Kansas Superior Select-All Plans | $41 | 117% |
| Blue Cross Blue Shield | $41 - $57 | 117% |
| Multiplan-All Plans | $109 | 311% |
| Uhhis-All Plans | $112 | 319% |
Consumer Guidance & Cost Commentary
For the CPT code 97530, representing occupational therapy therapeutic activities at Girard Medical Center in Girard, KS, the facility's cash median price is $71.00, while the median amount paid by insurance is $41.00. This cash rate is notably lower than the facility's gross charge of $118.00 and aligns closely with the state average for this service, which is $41.00. Patients with high-deductible plans may find it financially advantageous to pay the cash price of $71.00 directly, as this amount is lower than the negotiated rates charged by most in-network payers, which range from $41.00 to $206.00 depending on the specific insurance carrier.
While the facility's negotiated rates are generally consistent with the state average of $41.00, some commercial payers have significantly higher allowed amounts, such as UnitedHealthcare and Aetna, which can exceed the cash price. To maximize savings, patients should verify their specific plan's allowed amount before scheduling and inquire directly with the hospital about "self-pay" or "prompt-pay" discounts, which can further reduce the final bill. It is also important to request a full itemized bill to ensure no errors exist, as over 80% of hospital bills contain mistakes that can be corrected through a formal audit.