Occupational therapy (self-care training)
Facility: Kansas Surgery & Recovery Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $30
- Cash Discount Price: $59
- vs. Medicare Baseline: 0.93x 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 | $30 - $59 | 93% |
| Aetna | $30 - $52 | 93% |
| Blue Cross Blue Shield | $30 | 93% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, representing occupational therapy (self-care training), the Kansas Surgery & Recovery Center in Wichita, KS, lists a cash price of $59.00. This cash rate matches the facility's median negotiated rate of $30.00 and the state average of $59.00, indicating that paying out-of-pocket aligns with the typical cost for this service in Kansas. While the facility is an acute care hospital with a voluntary non-profit ownership structure, patients should be aware that commercial insurance rates often include administrative overhead that can inflate the baseline price by 20% to 40% compared to cash prices. Given that the cash price here equals the state average, patients with high-deductible plans might find that paying the full $59.00 upfront is more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if the negotiated rate exceeds the cash price or if the deductible has not yet been met.
The facility's billing data shows a gross charge of $59.00, which is 100% of the Medicare amount of $32.40, suggesting no markup above the federal benchmark for this specific service. However, the median negotiated rate of $30.00 represents the contractually agreed-upon ceiling for in-network payers like UnitedHealthcare, Aetna, and Blue Cross Blue Shield, all of which have a maximum allowed amount of $30.00 or $52.00 depending on the plan. To ensure you receive the best possible price, it is crucial to verify your specific plan's allowed amount before scheduling, as assuming in-network