Occupational therapy (therapeutic activities)
Facility: Centura St. Catherine-Dodge City
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $121
- Cash Discount Price: $65
- vs. Medicare Baseline: 3.45x 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 345% of the Medicare baseline (a markup of 245%). 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 |
|---|---|---|
| Cigna | $36 | 103% |
| Humana | $36 | 103% |
| Aetna | $36 - $131 | 103% |
| Medicare (plans) | $36 | 103% |
| Blue Cross Blue Shield | $36 - $67 | 103% |
| Kansas Health | $36 | 103% |
| Kaiser | $36 | 103% |
| Centura Employee Plan | $72 | 205% |
| UnitedHealthcare | $105 - $108 | 299% |
| Wpaa | $112 - $115 | 319% |
| Multiplan | $128 - $147 | 365% |
| Christian Health Aid | $128 - $131 | 365% |
| Health Partners Of Kansas | $144 - $147 | 411% |
Consumer Guidance & Cost Commentary
For the CPT code 97530, representing occupational therapy therapeutic activities, the facility's cash median rate of $65.00 is significantly lower than the state average of $121.00. While commercial payers like UnitedHealthcare and Multiplan negotiate rates ranging from $105 to $147, these amounts often exceed the cash price, making self-pay a potentially more cost-effective option for patients with high-deductible plans. It is important to note that the facility's negotiated rate of $121.00 is roughly 3.5 times the Medicare benchmark of $35.07, illustrating how commercial contracts can inflate costs compared to the federal baseline. Patients should verify their specific plan's allowed amount before scheduling, as some in-network rates may still be higher than the cash price.
To minimize unexpected costs, consumers should proactively request a prompt-pay discount or self-pay classification before check-in, which can bypass the administrative overhead of insurance billing. If a balance bill arises from an out-of-network service or ancillary charge, patients should not immediately pay the full amount; instead, they should dispute the bill with their insurer and request a No Surprises Act audit if applicable. Furthermore, since over 80% of hospital bills contain errors, patients should demand a full itemized CPT-coded statement rather than accepting a summary bill, ensuring that charges for unbundled services or items not rendered are identified and corrected through a formal written audit dispute.