Occupational therapy (self-care training)
Facility: Kansas City Orthopaedic Institute
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $105
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.24x 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 324% of the Medicare baseline (a markup of 224%). 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 | $41 - $125 | 127% |
| UnitedHealthcare | $41 - $124 | 127% |
| Aetna | $41 | 127% |
| Blue Cross Blue Shield | $82 - $120 | 253% |
| Medica | $172 | 531% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Kansas City Orthopaedic Institute in Leawood, KS, the facility's negotiated rates range from $41 to $172 depending on the insurance carrier, with a median negotiated payment of $105.00. This facility is owned by a physician and operates as an Acute Care Hospital. While the data does not provide specific cash or median paid figures for this service, patients should be aware that cash-pay options can sometimes be more cost-effective than insurance claims, particularly for those with high-deductible plans where the insurer's allowed amount might exceed the cash price. It is always advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts before scheduling care, as these upfront payment incentives can significantly reduce out-of-pocket costs by bypassing administrative fees and claims processing delays.
The facility's pricing structure is evaluated against federal benchmarks to ensure transparency. The Medicare amount for this procedure is $32.40, which serves as the objective baseline for evaluating commercial rate markups. While the provided data does not include specific Kansas or county average comparisons for this code, the No Surprises Act protects patients from balance billing for out-of-network providers at in-network facilities, preventing unexpected charges for emergency or non-emergency services. Consumers should avoid accepting summary bills that obscure individual charges and instead request a full itemized statement to verify that no unbundled codes or services not rendered have been included. If a patient receives a bill that appears to include balance billing, they should dispute the charge with their insurer and request a No Surprises Act audit rather than paying immediately out of fear of credit damage.