Occupational therapy (self-care training)
Facility: Salina Regional Health Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $105
- Cash Discount Price: $82
- vs. Medicare Baseline: 3.24x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 324% of the Medicare baseline (a markup of 224%). 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 | $36 - $38 | 111% |
| Preferred Phsic | $39 - $139 | 120% |
| Preferred Healthcare - All Other Plans | $53 - $188 | 164% |
| Providers Care (Wppa)-All Plans | $58 - $209 | 179% |
| Cigna | $58 - $209 | 179% |
| Aetna | $58 - $209 | 179% |
| Multiplan (Mpi)-All Plans | $58 - $209 | 179% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, Occupational therapy (self-care training), Salina Regional Health Center in Salina, KS, has a cash median price of $82.00 and a negotiated median paid amount of $88.00. This cash rate is significantly lower than the facility's gross charge of $117.00 and represents a substantial discount compared to the commercial negotiated rates, which range from $36 to $209 depending on the insurance plan. While the facility is an Acute Care Hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance contracts often result in higher allowed amounts than cash prices; therefore, paying cash or utilizing a prompt-pay discount may be the most cost-effective option for those with high-deductible plans or those who have met their deductible.
The facility's pricing is evaluated against the Medicare benchmark, which stands at $32.40 for this service. The cash median of $82.00 is approximately 2.5 times the Medicare rate, reflecting the standard administrative markup and provider costs inherent in commercial billing, though it remains well below the gross chargemaster. To ensure you are not overcharged, it is advisable to request a full itemized bill before finalizing payment, as summary bills can obscure specific line items and potential errors. Additionally, patients should explicitly ask about self-pay or prompt-pay discounts prior to scheduling, as these upfront fee reductions can bypass the administrative overhead of insurance claims processing and result in immediate savings.