Occupational therapy (self-care training)
Facility: St. Catherine Hospital - Garden City
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $150
- Cash Discount Price: $128
- vs. Medicare Baseline: 4.63x 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 463% of the Medicare baseline (a markup of 363%). 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 |
|---|---|---|
| UnitedHealthcare | $32 - $236 | 99% |
| Humana | $33 | 102% |
| Medicare (plans) | $33 | 102% |
| Aetna | $33 - $321 | 102% |
| Innovage | $33 | 102% |
| Kaiser | $33 - $88 | 102% |
| Kansas Health | $33 | 102% |
| Blue Cross Blue Shield | $33 - $205 | 102% |
| Devoted Health | $33 | 102% |
| Cigna | $33 - $202 | 102% |
| Centura Employee Plan | $72 | 222% |
| Direct To Employer | $75 - $128 | 231% |
| Denver Health | $76 | 235% |
| Peak Health | $99 - $125 | 306% |
| Wpaa | $125 - $267 | 386% |
| Multiplan | $131 - $355 | 404% |
| Christian Health Aid | $142 - $305 | 438% |
| United Colorado Doctor'S Plan | $143 - $150 | 441% |
| Health Partners Of Kansas | $173 - $370 | 534% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at St. Catherine Hospital in Garden City, KS, the facility's cash price of $128.00 is significantly lower than the state average of $150.00 and the county average of $150.00. While many commercial payers have negotiated rates ranging from $33 to $370, the cash price remains competitive, particularly for patients with high-deductible plans where the insurance allowed amount might exceed the cash rate. It is important to note that while the facility is a voluntary non-profit church-owned acute care hospital, the negotiated rates vary widely; for instance, UnitedHealthcare plans range from $32 to $236, whereas Multiplan plans can reach up to $355. Patients should verify their specific plan's allowed amount before scheduling, as the negotiated rate for their insurer may differ substantially from the facility's cash price.
To maximize savings, patients should proactively ask the billing department about "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront, bypassing the administrative costs associated with insurance claims. Additionally, if you receive a bill from an out-of-network provider or for services not covered by your plan, you may be subject to balance billing, though the No Surprises Act protects you from surprise bills for emergency care and non-emergency services at in-network facilities. If you receive an itemized bill, review it carefully for errors or unbundled codes, as over 80% of hospital bills contain mistakes that can be corrected through a formal written audit dispute. For context, the Medicare benchmark for this service is