Occupational therapy (self-care training)
Facility: Saint John Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $31
- Cash Discount Price: $30
- vs. Medicare Baseline: 0.96x 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 $32.4 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 |
|---|---|---|
| UnitedHealthcare | $19 - $43 | 59% |
| Medicaid / KanCare | $19 | 59% |
| Healthy Blue | $20 - $32 | 62% |
| Celtic | $20 - $79 | 62% |
| Kansas Superior Select | $31 | 96% |
| Medicare (plans) | $31 | 96% |
| Aetna | $31 - $47 | 96% |
| Midland Care Connection | $31 | 96% |
| Tricare | $31 | 96% |
| Cigna | $31 | 96% |
| Well Path | $43 | 133% |
| Employer Direct Healthcare | $43 | 133% |
| Corizon | $43 | 133% |
| Centurion | $46 | 142% |
| Naphcare | $47 | 145% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at Saint John Hospital in Leavenworth, KS, the cash price of $30.00 is significantly lower than the facility's negotiated rates with major payers, which range from $19 to $79 depending on the insurance plan. While the hospital's cash rate is notably lower than the state average for this procedure, patients with high-deductible plans may find the cash price more affordable than their specific insurance allowed amount, which varies widely across the 15 payer plans listed. It is important to note that commercial negotiated rates often include administrative overhead and contract dynamics that can inflate the final cost compared to the direct cash price, making it a strategic option to verify self-pay or prompt-pay discounts before scheduling to avoid unexpected out-of-pocket expenses.
The facility's cash rate of $30.00 is also lower than the Medicare benchmark of $32.40, which serves as a scientifically validated baseline for the true cost of care delivery. Although the data does not provide a specific median paid amount or a direct comparison to county averages, the significant gap between the cash price and the highest negotiated rates (up to $79) highlights the potential for substantial savings by paying directly. Consumers should be aware that balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities under the No Surprises Act, but it is crucial to request an itemized bill to ensure no unbundled codes or services not rendered are included. If a patient receives a bill exceeding the cash price, they should dispute it in writing with the billing supervisor rather than accepting summary invoices or signing away rights to out-of-network protections.