Occupational therapy (self-care training)
Facility: Centura St. Catherine-Dodge City
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $142
- Cash Discount Price: $112
- vs. Medicare Baseline: 4.38x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 438% of the Medicare baseline (a markup of 338%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 |
|---|---|---|
| Cigna | $33 | 102% |
| Kansas Health | $33 | 102% |
| Aetna | $33 - $305 | 102% |
| Blue Cross Blue Shield | $33 - $40 | 102% |
| Medicare (plans) | $33 | 102% |
| Kaiser | $33 | 102% |
| Humana | $33 | 102% |
| Centura Employee Plan | $72 | 222% |
| UnitedHealthcare | $117 - $251 | 361% |
| Wpaa | $125 - $267 | 386% |
| Multiplan | $142 - $344 | 438% |
| Christian Health Aid | $142 - $305 | 438% |
| Health Partners Of Kansas | $160 - $344 | 494% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, representing occupational therapy (self-care training), the facility's cash median rate is $112.00, which is significantly lower than the state average of $142.00. While commercial insurance plans like Aetna and Multiplan have negotiated rates ranging from $33 to $344, these figures often exceed the cash price due to administrative overhead and contract structures. Under Medicare benchmarking principles, the federal baseline for this service is $32.40, meaning commercial negotiated rates frequently represent a markup well above the true cost of delivery. Patients with high-deductible plans may find paying the cash rate of $112.00 more financially advantageous than relying on insurance, particularly if their plan's negotiated allowed amount exceeds the cash price but leaves them with a high out-of-pocket balance before meeting their deductible.
To maximize savings, consumers should verify "self-pay" or "prompt-pay" discounts directly with the hospital before scheduling, as these upfront payment incentives can bypass costly claims processing and administrative fees. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to request an itemized billing audit to ensure no unbundled codes or services not rendered are included in the final statement. Given that over 80% of hospital bills contain errors, reviewing the detailed line items is essential to confirm the accuracy of charges against the facility's published rates and the state average.