Occupational therapy (self-care training)
Facility: Pratt Regional Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $80
- Cash Discount Price: $67
- vs. Medicare Baseline: 2.47x 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 247% of the Medicare baseline (a markup of 147%). 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 |
|---|---|---|
| Celtic Insurance Company | $31 | 96% |
| Healthy Blue | $32 | 99% |
| UnitedHealthcare | $34 - $103 | 105% |
| Christian Health Aid | $67 - $76 | 207% |
| Health Partners Of Kansas | $76 - $86 | 235% |
| Aetna | $80 - $91 | 247% |
| Choicecare | $89 - $101 | 275% |
Consumer Guidance & Cost Commentary
At Pratt Regional Medical Center, the negotiated rates for Occupational therapy (self-care training) range from $31 to $103 depending on your specific insurance plan, with UnitedHealthcare showing the widest variation between $34 and $103 across five plans. While the facility's cash price of $67 is lower than the median negotiated rate of $80, patients with high-deductible plans may find paying cash upfront more cost-effective if their insurance allowed amount exceeds the cash price. It is important to note that the facility's cash rate of $67 is significantly higher than the state of Kansas average, which is reflected in the $32.40 Medicare benchmark. To maximize savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
The facility's pricing structure is anchored by a Medicare benchmark of $32.40, which serves as the objective baseline for evaluating commercial markups. Although the gross charge is $95, the negotiated rates for in-network payers like Celtic Insurance Company and Healthy Blue are fixed at $31 and $32 respectively, demonstrating that contractually agreed-upon prices can be lower than the cash option for some plans. However, payers such as Choicecare and UnitedHealthcare have negotiated rates that exceed the cash price, highlighting the importance of verifying your specific plan's allowed amount before assuming insurance will be cheaper. If you receive a bill that appears higher than expected, you should request a full itemized CPT-coded statement to identify any errors, double-billing, or unbund