Occupational therapy (self-care training)
Facility: Lmh
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $31
- Cash Discount Price: $43
- 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 |
|---|---|---|
| UnitedHealthcare | $20 - $172 | 62% |
| Blue Cross Blue Shield | $20 - $112 | 62% |
| Allwell | $27 - $31 | 83% |
| Aetna | $29 - $143 | 90% |
| Haskell Indian Health Services | $31 | 96% |
| Cigna | $31 - $115 | 96% |
| Medicare (plans) | $31 | 96% |
| Humana | $31 | 96% |
| Ambetter / Centene | $40 - $47 | 123% |
| Non Contracted | $138 | 426% |
| First Health | $160 | 494% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service, the facility's cash price of $43.00 is significantly lower than the negotiated rates charged by most commercial insurers, which range from $20 to $172 depending on the plan. While the facility is a government-owned acute care hospital in Lawrence, KS, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as many commercial negotiated rates exceed the cash amount. It is important to note that while the facility offers a cash rate of $43.00, the Medicare benchmark for this service is $32.40, indicating that the cash price is slightly above the federal baseline but remains a substantial discount compared to the full chargemaster gross of $173.00.
To minimize out-of-pocket costs, patients should proactively ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the final bill by 20% to 50% if paid upfront. Since the facility is in-network for many payers, patients must verify their specific deductible status before scheduling, as high negotiated rates can still result in significant costs if the deductible has not been met. Additionally, if a patient receives a bill after using insurance, they should request a full itemized audit to identify any errors or unbundled charges, as over 80% of hospital bills contain mistakes that can be corrected. By comparing the facility's rates directly to the Medicare benchmark and seeking prompt-pay incentives, patients can avoid balance billing and ensure they are paying a fair price for their care.