Occupational therapy (self-care training)
Facility: Labette Health
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $41
- Cash Discount Price: $51
- vs. Medicare Baseline: 1.27x 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.
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 |
|---|---|---|
| Uhccp | $14 | 43% |
| Ambetter / Centene | $18 - $47 | 56% |
| Medicaid / KanCare | $20 - $41 | 62% |
| Healthy Blue | $20 | 62% |
| Montgomery County | $24 | 74% |
| Blue Cross Blue Shield | $34 - $41 | 105% |
| Wellcare | $41 | 127% |
| Humana | $41 | 127% |
| UnitedHealthcare | $41 - $64 | 127% |
| Multiplan | $62 | 191% |
| Health Partners Of Kansas, Inc | $66 | 204% |
| Choicecare (First Health Network) | $66 | 204% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service, Labette Health in Parsons, KS, lists a gross charge of $73.00, which is significantly higher than the state average of $51.00 for cash payments. While the facility offers a negotiated rate of $41.00 for in-network patients, this amount remains above the cash price. This pricing structure highlights a common billing dynamic where commercial insurance contracts often result in higher out-of-pocket costs for patients with high deductibles, as the negotiated rate can exceed the cash-pay option. To minimize costs, patients should verify their specific plan's deductible status and consider paying the cash rate directly, potentially securing an additional prompt-pay discount if available.
The facility's pricing is also notable when compared to the Medicare benchmark of $32.40, indicating a markup of 1.3 times the federal rate. This comparison underscores the importance of understanding that commercial rates are not fixed by law but are subject to negotiation and administrative overhead. Patients should be aware that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, it is crucial to request an itemized bill to ensure no unbundled charges or services not rendered are included. Always confirm with the hospital whether "self-pay" or "prompt-pay" discounts apply before scheduling, as these upfront incentives can significantly reduce the final amount owed compared to standard insurance processing.