Occupational therapy (self-care training)
Facility: Providence Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $32
- Cash Discount Price: $30
- vs. Medicare Baseline: 0.99x 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 |
|---|---|---|
| Aetna | $18 - $47 | 56% |
| UnitedHealthcare | $19 - $137 | 59% |
| Medicaid / KanCare | $19 | 59% |
| Healthy Blue | $20 - $32 | 62% |
| Celtic | $20 - $49 | 62% |
| Blue Cross Blue Shield | $31 - $73 | 96% |
| Tricare | $31 | 96% |
| Midland Care Connection | $31 | 96% |
| Medicare (plans) | $31 | 96% |
| Cigna | $31 | 96% |
| Kansas Superior Select | $32 | 99% |
| Corizon | $40 | 123% |
| Employer Direct Healthcare | $43 | 133% |
| Well Path Prison | $43 | 133% |
| Centurion | $46 | 142% |
| Naphcare | $47 | 145% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at Providence Medical Center in Kansas City, KS, the cash median price is $30.00, which is significantly lower than the negotiated rates paid by insurance carriers. While commercial payers like Aetna and UnitedHealthcare negotiate rates ranging from $18 to $137, the cash price remains the most affordable option for patients without insurance or those with high-deductible plans. Because insurance billing involves administrative overhead and claim processing costs, the cash price often represents the true cost of care, whereas negotiated rates can be inflated by 200% to 300% of the Medicare benchmark of $32.40. Patients should verify if their specific plan has a deductible that must be met before these negotiated rates apply, as paying out-of-pocket may result in immediate savings.
To maximize potential savings, patients should proactively request a "prompt-pay" discount from the hospital before scheduling their visit, as these discounts can reduce bills by 20% to 50% for upfront payment. It is crucial to sign a waiver of insurance submission to ensure the hospital processes the account as self-pay rather than submitting a claim that would void the cash agreement. Additionally, if a patient receives a bill from an out-of-network provider at this facility, they may be subject to balance billing for the difference between the allowed amount and the full charge; however, the No Surprises Act generally protects patients from such surprise bills for emergency care and non-emergency services at in-network facilities. Always request a full itemized audit of any bill to identify errors, unbundled codes, or services not rendered, as over 80% of hospital bills contain discrepancies