Occupational therapy (self-care training)
Facility: Wesley Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $39
- Cash Discount Price: $443
- vs. Medicare Baseline: 1.20x 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 |
|---|---|---|
| UnitedHealthcare | $19 | 59% |
| Aetna | $20 - $200 | 62% |
| Amerigroup | $20 | 62% |
| Medicaid / KanCare | $20 | 62% |
| Humana | $27 - $31 | 83% |
| Devoted Health | $27 - $31 | 83% |
| United | $27 - $199 | 83% |
| Coventry Health Care | $27 - $31 | 83% |
| Ambetter / Centene | $28 - $80 | 86% |
| Triwest Health Alliance | $30 | 93% |
| Blue Cross Blue Shield | $38 | 117% |
| Correct Care Solutions | $40 - $46 | 123% |
| First Health | $44 - $204 | 136% |
| Multiplan | $46 - $399 | 142% |
| Wppa | $77 | 238% |
| Health Partners Of Kansas | $77 - $222 | 238% |
| Preferred Health Choices | $84 | 259% |
| Medical Associates Health Plan | $84 | 259% |
| Spirit Aerosystems | $142 | 438% |
| Triwest Healthcare Alliance | $288 | 889% |
| Usa Managed Care | $377 | 1164% |
Consumer Guidance & Cost Commentary
For CPT code 97535, representing occupational therapy (self-care training), the cash price at Wesley Medical Center in Wichita, KS, is $443.00. This cash rate is significantly higher than the state average, which is $32.40 (Medicare amount). While commercial insurance plans like UnitedHealthcare and Aetna negotiate rates ranging from $19 to $200, these negotiated amounts often exceed the cash price. Patients with high-deductible plans may find paying the $443.00 cash rate directly more cost-effective than relying on insurance, as the insurer's allowed amount could be substantially higher. To minimize costs, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid in full upfront.
This service is provided by an Acute Care Hospital with a Proprietary ownership structure, and the facility holds a 4-star rating. Because commercial rates are often inflated by administrative overhead and contract dynamics, the cash price serves as a critical benchmark for transparency. If you are billed by an out-of-network provider or receive unexpected charges, you may be subject to balance billing, where the provider bills you for the difference between their full chargemaster rate and what your insurance pays. Under the No Surprises Act, balance billing is generally prohibited for emergency care and non-emergency services at in-network facilities. If you receive a surprise bill, you should dispute it in writing with the insurer rather than paying immediately, and request a formal itemized audit to identify any unbundled codes or services not rendered.