Occupational therapy (therapeutic activities)
Facility: Smith County Memorial Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $88
- Cash Discount Price: $94
- 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% |
| Medicaid / KanCare | $66 - $94 | 188% |
| Multiplan-All Plans | $85 | 242% |
| Wppa-All Plans | $88 | 251% |
| UnitedHealthcare | $89 | 254% |
| Midlands Choice-All Plans | $89 | 254% |
| Health Partners Of Ks Ppo-All Plans | $89 | 254% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (therapeutic activities) service at Smith County Memorial Hospital in Smith Center, KS, the cash price is $94.00, which matches the facility's median negotiated rate of $89.00 and the cash median reported for the region. This service is significantly priced higher than the Medicare benchmark of $35.07, reflecting a markup of 2.5 times the federal rate. While Medicaid / KanCare plans have a wide range of negotiated rates between $66 and $94, commercial payers like Blue Cross Blue Shield and Multiplan-All Plans have fixed negotiated rates of $49 and $85, respectively. Patients with high-deductible plans may find that paying the cash price of $94.00 upfront is more cost-effective than relying on insurance, as the negotiated rates for many commercial plans exceed the cash amount, and the administrative costs of claims processing often inflate the final bill.
To minimize costs, patients should verify their specific plan's negotiated rate before scheduling, as in-network status does not guarantee the lowest possible price. It is important to ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full upfront, bypassing the administrative overhead of insurance billing. If a patient receives a bill that includes charges for services not rendered or unbundled components, they should request a full itemized audit rather than accepting a summary invoice. Additionally, under the No Surprises Act, patients are protected from balance billing for out-of-network services at in-network facilities, so any unexpected charges should be disputed with the insurer rather than paid immediately.