Occupational therapy (therapeutic activities)
Facility: Kingman Healthcare Center
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $136
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.88x 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 388% of the Medicare baseline (a markup of 288%). 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 |
|---|---|---|
| Humana | $136 | 388% |
Consumer Guidance & Cost Commentary
For this Occupational therapy service at Kingman Healthcare Center in Kingman, KS, the negotiated rate is $136.00, which matches the lowest and highest reported values for Humana. This specific rate is significantly higher than the Medicare benchmark of $35.07, reflecting a markup of 390% above the federal baseline. While commercial insurance contracts often result in rates exceeding 200% of Medicare due to administrative costs and network dynamics, patients with high-deductible plans may find paying the cash price directly more economical if the facility offers a self-pay discount that brings the total below the insurance allowed amount. It is crucial to verify the facility's "self-pay" or "prompt-pay" rates before scheduling, as paying upfront can sometimes bypass the higher administrative fees embedded in insurance billing cycles.
Patients should be aware that the $136.00 figure represents a contractually agreed-upon ceiling with Humana, not the full chargemaster list price, and it does not account for potential balance billing if out-of-network ancillary services are involved. To ensure accuracy, consumers should request a full itemized bill containing specific CPT codes rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled charges or services not rendered. If a balance bill arises from an out-of-network provider at this in-network facility, the No Surprises Act may protect you from paying the difference, so you should dispute any unexpected charges with your insurer rather than paying immediately out of fear of credit damage. Always confirm your deductible status before using insurance, as paying the negotiated rate without meeting your deductible threshold could result in higher out-of-pocket costs than paying cash directly