Occupational therapy (self-care training)
Facility: Saint Luke'S South Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $93
- Cash Discount Price: $142
- vs. Medicare Baseline: 2.87x 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 287% of the Medicare baseline (a markup of 187%). 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 |
|---|---|---|
| Medicaid / KanCare | $19 - $42 | 59% |
| Aetna | $20 - $225 | 62% |
| Transplants-Case Rates [5750] | $28 - $237 | 86% |
| UnitedHealthcare | $31 - $127 | 96% |
| Blue Cross Blue Shield | $41 - $93 | 127% |
| Humana | $57 - $76 | 176% |
| Cigna | $64 - $289 | 198% |
| First Health [5512] | $140 | 432% |
| Commercial-Contracted [8000] | $178 - $203 | 549% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, Occupational therapy (self-care training), Saint Luke's South Hospital in Overland Park, KS, lists a cash median price of $142.00, which is significantly higher than the state average of $28.00. While the facility's cash rate exceeds the state median, patients with high-deductible plans may find paying out-of-pocket cheaper if their insurance negotiated rate exceeds this cash price. It is important to note that the facility's cash rate is also 2.9 times the Medicare benchmark of $32.40, illustrating that commercial rates often carry substantial markups compared to the federal government's cost-based baseline.
Commercial insurance payers negotiate rates that frequently exceed cash prices due to administrative overhead and contract structures. For this service, the median negotiated rate across payers is $93.00, which is lower than the cash price but still represents a markup relative to the Medicare amount. Patients should verify their specific plan's allowed amount before scheduling, as in-network rates vary widely among the nine payers listed, ranging from $19 to $289. To potentially reduce costs, patients are encouraged to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can offer immediate fee reductions for upfront payment.