Occupational therapy (self-care training)
Facility: Overland Park Reg Med Ctr
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $64
- Cash Discount Price: $339
- vs. Medicare Baseline: 1.98x 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 |
|---|---|---|
| Amerigroup | $19 | 59% |
| United | $19 - $175 | 59% |
| Medicaid / KanCare | $20 | 62% |
| Aetna | $20 - $198 | 62% |
| Unicare | $20 | 62% |
| Healthyblue | $20 | 62% |
| Wellcare | $27 - $31 | 83% |
| Devoted Health | $27 - $31 | 83% |
| Blue Cross Blue Shield | $27 - $167 | 83% |
| Humana | $27 - $68 | 83% |
| Celtic | $27 - $31 | 83% |
| Cigna | $27 - $31 | 83% |
| Coventry | $27 - $156 | 83% |
| Pyramid Life | $29 - $33 | 90% |
| Home State Health Plan | $29 | 90% |
| Triwest Health Alliance | $30 | 93% |
| Multiplan | $37 - $288 | 114% |
| Corvel Corporation | $44 - $253 | 136% |
| Oha Network | $46 - $195 | 142% |
| Ambetter / Centene | $54 - $72 | 167% |
| Nhc Advantage | $55 - $74 | 170% |
| Oscar | $55 - $74 | 170% |
| Wppa Providrs Care Network | $58 - $78 | 179% |
| Universal Healthcare | $101 - $136 | 312% |
| Coventry Kc Mo | $118 - $160 | 364% |
| College Park Family Care Center | $124 - $167 | 383% |
| Focus Healthcare Mgmt, Inc | $217 - $292 | 670% |
| Cco, Inc. | $217 - $292 | 670% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, representing occupational therapy (self-care training), the facility's cash price is $339.00, which matches the cash median for this service. This rate is significantly higher than the Medicare benchmark of $32.40, reflecting a markup of 2.0 times the federal rate. While commercial insurance plans negotiate rates that act as a ceiling to protect members, these negotiated amounts often exceed the cash price due to administrative overhead and contract structures. For example, United Health plans negotiate a rate as high as $175, while Aetna plans can reach up to $198, both of which are lower than the gross charge but still above the cash-pay option. Patients with high-deductible plans may find it financially advantageous to pay the $339.00 cash price directly, as this avoids the administrative costs and potential higher negotiated rates associated with insurance billing.
To minimize costs, consumers should verify if the facility offers "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can bypass the standard insurance billing cycle and reduce administrative fees. It is important to note that while the facility is in-network for many payers, the negotiated rates vary widely; for instance, Amerigroup has a fixed rate of $19, whereas Multiplan plans can reach $288. Because commercial rates often include multi-layered administrative structures that inflate the baseline price by 20% to 40%, patients should request an itemized bill to ensure no errors or unbundled charges are present. Ultimately, comparing the facility's cash rate against the Medicare benchmark provides a clearer picture of the true cost of care