Occupational therapy (self-care training)
Facility: Mcpherson Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $90
- Cash Discount Price: $80
- vs. Medicare Baseline: 2.78x 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 278% of the Medicare baseline (a markup of 178%). 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 |
|---|---|---|
| Tricare | $27 | 83% |
| UnitedHealthcare | $31 - $114 | 96% |
| Humana | $31 | 96% |
| Va Ccn - All Plans | $31 | 96% |
| Blue Cross Blue Shield | $31 | 96% |
| Healthy Blue Mcr Adv | $31 | 96% |
| Wellcare Mcr Adv - All Plans | $31 | 96% |
| Ambetter / Centene | $35 | 108% |
| Wppa - All Plans | $71 - $80 | 219% |
| Medical Associates - All Plans | $76 - $86 | 235% |
| Central Plains - All Plans | $76 - $86 | 235% |
| Christian Health Aid - All Plans | $81 - $91 | 250% |
| Aetna | $83 - $114 | 256% |
| Multiplan - All Plans | $91 - $103 | 281% |
| First Health - All Plans | $96 - $108 | 296% |
| Cigna | $96 - $108 | 296% |
| Health Partners - All Plans | $96 - $108 | 296% |
| Medicaid / KanCare | $101 - $114 | 312% |
| Health Blue Mcaid - All Other Plans | $103 - $116 | 318% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service, McPherson Hospital in Kansas has a cash median price of $80.00, which is lower than the state average of $90.00. While many commercial payers negotiate rates ranging from $27 to $116, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying cash directly. It is important to note that commercial negotiated rates frequently include administrative overhead and are not the lowest possible cost; in this case, the cash rate is significantly lower than the median negotiated amount of $90.00. Patients should verify their specific plan's allowed amount before scheduling, as some in-network rates may still be higher than the facility's self-pay price.
To avoid unexpected costs, consumers should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. Additionally, if you are using insurance, be aware of the No Surprises Act, which protects you from balance billing for out-of-network services at in-network facilities, though you should still request an itemized bill to ensure no errors exist. Since over 80% of hospital bills contain mistakes, always review your statement line-by-line to confirm that all services rendered are accurately coded and that no unbundled charges or cancelled items have been billed.