Occupational therapy (self-care training)
Facility: Menorah Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $42
- Cash Discount Price: $224
- vs. Medicare Baseline: 1.30x 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 |
|---|---|---|
| United | $19 - $101 | 59% |
| Amerigroup | $19 | 59% |
| Unicare | $20 | 62% |
| Medicaid / KanCare | $20 | 62% |
| Healthyblue | $20 | 62% |
| Aetna | $20 - $114 | 62% |
| Devoted Health | $27 - $31 | 83% |
| Humana | $27 - $68 | 83% |
| Cigna | $27 - $179 | 83% |
| Blue Cross Blue Shield | $27 - $101 | 83% |
| Celtic | $27 - $31 | 83% |
| Wellcare | $27 - $31 | 83% |
| Coventry | $27 - $90 | 83% |
| Pyramid Life | $29 - $33 | 90% |
| Home State Health Plan | $29 | 90% |
| Triwest Health Alliance | $30 | 93% |
| Multiplan | $37 - $165 | 114% |
| Oscar | $42 | 130% |
| Nhc Advantage | $42 | 130% |
| Ambetter / Centene | $42 | 130% |
| Corvel Corporation | $44 - $145 | 136% |
| Wppa Providrs Care Network | $45 | 139% |
| Oha Network | $46 - $112 | 142% |
| Universal Healthcare | $78 | 241% |
| Coventry Kc Mo | $92 | 284% |
| College Park Family Care Center | $96 | 296% |
| Cco, Inc. | $168 | 519% |
| Focus Healthcare Mgmt, Inc | $168 | 519% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, representing occupational therapy (self-care training), the cash price at Menorah Medical Center in Overland Park, KS, is $224.00. This cash rate is significantly higher than the state average, which is $32.40, and the Medicare benchmark, which is $32.40. While the facility offers a negotiated rate of $42.00 for commercial payers, this amount remains well above the Medicare baseline. Patients with high-deductible plans should consider that paying cash upfront might be more cost-effective than using insurance, as the negotiated rates often exceed the cash price due to administrative overhead and contract dynamics. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, which could further reduce the final cost.
The facility's pricing structure reflects a wide range of negotiated rates across 28 different payers, with allowed amounts varying from $19 to $168 depending on the insurance carrier. For instance, United and Amerigroup have the lowest negotiated rates at $19, while Cco, Inc. and Focus Healthcare Mgmt, Inc. have the highest at $168. Because these rates are contractually agreed-upon ceilings, they do not necessarily represent the lowest possible price for a patient. To avoid unexpected costs, consumers should request an itemized bill before scheduling services to ensure no unbundled codes or services not rendered are included. If a balance bill arises from out-of-network ancillary services, patients should be aware of federal protections under the No Surprises Act, which may prevent them from being charged the difference between the facility