Occupational therapy (self-care training)
Facility: Ascension Via Christi Hospital Manhattan, Inc
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $31
- Cash Discount Price: $45
- 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 | $19 - $85 | 59% |
| Aetna | $20 | 62% |
| Medicaid / KanCare | $20 - $28 | 62% |
| Humana | $30 - $31 | 93% |
| Va | $30 | 93% |
| Medicare (plans) | $30 - $31 | 93% |
| Blue Cross Blue Shield | $37 - $39 | 114% |
| Providrs Care | $40 | 123% |
| Smarthealth | $42 | 130% |
| Ambetter / Centene | $51 | 157% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service, the facility's cash median price of $45.00 is significantly lower than the negotiated rates paid by major payers, which range from $19 to $51 depending on the insurance plan. While the gross charge is $113.00, patients with high-deductible plans may find paying the cash price directly more cost-effective than relying on insurance, as the negotiated rates often exceed the cash amount. To maximize savings, it is recommended to explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
The facility's pricing aligns closely with federal benchmarks, with the Medicare allowed amount of $32.40 serving as a reliable baseline for evaluating commercial rates. Although the data does not provide specific state or county average comparisons for this code, the facility's negotiated rates generally fall within the typical range of 120% to 150% of the Medicare rate, which represents a fair pricing standard. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, it is still essential to review any itemized bills for unbundled codes or services not rendered to ensure accuracy before finalizing payment.