Occupational therapy (self-care training)
Facility: Ascension Via Christi Hospitals Wichita, Inc.
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $31
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 0.96x 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 |
|---|---|---|
| Saint Lukes Health Systems | $30 | 93% |
| Vc Hope | $30 | 93% |
| Medicare (plans) | $30 - $31 | 93% |
| Va | $30 | 93% |
| Via Christi Research | $30 | 93% |
| Humana | $30 | 93% |
| UnitedHealthcare | $31 - $85 | 96% |
| Blue Cross Blue Shield | $31 | 96% |
| Corizon | $38 | 117% |
| Smarthealth | $42 | 130% |
| Medicaid / KanCare | $51 | 157% |
| Coventry City Of Wichita | $77 | 238% |
| Aetna | $103 | 318% |
Consumer Guidance & Cost Commentary
For CPT code 97535, Occupational therapy (self-care training), at Ascension Via Christi Hospitals Wichita, Inc., the negotiated rates range from $30 to $103 across 13 different payers, with a median negotiated amount of $31.00. This facility is located in Wichita, Kansas, and its pricing aligns closely with the state average, as indicated by a Medicare benchmarking ratio of 1.0. While the facility is a voluntary non-profit acute care hospital, the data shows no specific cash or median paid values reported for this service. Patients should note that cash-pay rates are not listed here, but if the insurance negotiated rate exceeds the cash price, paying out-of-pocket could potentially result in lower costs, provided the patient has a high deductible plan. It is always advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can significantly reduce the final bill.
When reviewing your statement, be aware that commercial insurance rates often include administrative overhead and contract dynamics that can inflate the baseline price by 20% to 40% compared to the true cost of care. Since Medicare rates serve as a scientifically validated cost baseline, the fact that this facility's negotiated rates average 1.0 times the Medicare amount suggests pricing is fair relative to federal standards, rather than inflated by the hospital's full chargemaster list. If you receive a bill, ensure it is an itemized statement showing specific CPT codes to avoid paying for unbundled services or items not rendered. If you encounter unexpected charges, you have the right to dispute them in writing and request a review under federal protections, such as the No Surprises