Occupational therapy (self-care training)
Facility: University Of Kansas Health System - St Francis Campus
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $69
- Cash Discount Price: $50
- vs. Medicare Baseline: 2.13x 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 213% of the Medicare baseline (a markup of 113%). 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 |
|---|---|---|
| Black Lung [6055] | $69 | 213% |
| Web Tpa [2115] | $69 | 213% |
| Blue Cross Blue Shield | $69 | 213% |
| Hooray Health [8000] | $69 | 213% |
| Oncology Patient Assistance Programs [2295] | $69 | 213% |
| Healthcare Highways [2210] | $69 | 213% |
| Lucent Health [6000] | $69 | 213% |
| Aetna | $69 | 213% |
| Department Of Corrections [1340] | $84 | 259% |
| National Association Of Letter Carriers [1695] | $97 | 299% |
| Cigna | $97 | 299% |
| Healthpartners [1500] | $97 | 299% |
| American Postal Workers Union [1070] | $97 | 299% |
| Humana | $99 | 306% |
| American Healthcare [1055] | $131 | 404% |
| Administrative Concepts [1005] | $131 | 404% |
| Multiplan [1680] | $131 | 404% |
| First Health [1375] | $131 | 404% |
| Coventry Healthcare [1320] | $138 | 426% |
| Ks Disability Determination [6090] | $168 | 519% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service, the University Of Kansas Health System - St Francis Campus in Topeka, KS, lists a gross charge of $168.00. This amount is significantly higher than the state average for this procedure, which is $50.00 when paid in cash. While the facility's median negotiated rate across 20 payers is $69.00, this figure remains double the cash price. Patients with high-deductible plans or those without insurance may find that paying the cash price of $50.00 upfront is more cost-effective than relying on insurance, as the negotiated rates often exceed the cash rate. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling, as these incentives can further reduce the final cost.
The Medicare benchmark for this service is $32.40, which serves as a critical baseline for evaluating the facility's pricing markup. The gross charge of $168.00 represents a substantial increase over the federal government's calculated cost basis, highlighting the difference between the true cost of care and the commercial chargemaster. If you receive a bill from this facility, you should request a detailed, itemized statement to ensure no errors, such as unbundled codes or services not rendered, have inflated the total. Be aware that while the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, it is essential to verify your specific plan's network status and deductible requirements before accepting any insurance payment to avoid unexpected out-of-pocket expenses.