Occupational therapy (self-care training)
Facility: University Of Ks Hlth System Great Bend Campus
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $74
- Cash Discount Price: $25
- vs. Medicare Baseline: 2.28x 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 228% of the Medicare baseline (a markup of 128%). 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 |
|---|---|---|
| Workers Comp [503999901] | $30 - $105 | 93% |
| Ku Athletics [503200094] | $30 | 93% |
| UnitedHealthcare | $30 - $92 | 93% |
| Humana | $30 | 93% |
| Blue Cross Blue Shield | $31 - $34 | 96% |
| Allwell [503200078] | $31 | 96% |
| Medicare (plans) | $31 | 96% |
| Centurion [5032000966] | $39 | 120% |
| Ambetter / Centene | $44 | 136% |
| Alt Wppa [5032000964] | $52 | 160% |
| Wppa [503200056] | $52 | 160% |
| Meritain Health [503200039] | $52 - $74 | 160% |
| Alt Carelon Behavioral Health [503200905] | $62 | 191% |
| Alt Meritain Health [503999911] | $74 | 228% |
| Cigna | $74 - $98 | 228% |
| Php [503200005] | $74 | 228% |
| Aha-Healthcare Preferred [503200050] | $74 | 228% |
| Allied National [503999937] | $74 | 228% |
| National Assn Letter Carriers [503200019] | $74 | 228% |
| First Health [5032000110] | $74 | 228% |
| Aetna | $74 | 228% |
| 6 Degrees Health [503999050] | $76 | 235% |
| Correct Care Solutions [50311253] | $86 | 265% |
| Occunet [503999930] | $90 | 278% |
| Fort Hays State Student Athletes [5032000960] | $90 | 278% |
| Advanced Medical Pricing Solutions [503301513] | $91 | 281% |
| Geha [503200036] | $92 | 284% |
| Medica [503200074] | $92 | 284% |
| Usa Managed Care [503999030] | $111 | 343% |
| Hchsync Centrus Health Direct [503999916] | $130 - $150 | 401% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service (CPT 97535) at the University Of Ks Hlth System Great Bend Campus, the cash price is $25.00, which is significantly lower than the facility's gross charge of $123.00. While the facility's negotiated rates with insurance payers range from $30 to $150, the cash price of $25.00 is notably lower than the state average for this procedure. Patients with high-deductible plans or those without insurance may find the cash price most economical, as it avoids the administrative layers and markup inherent in insurance billing. It is important to note that while the facility offers a cash rate, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can further reduce costs by bypassing the costly claims processing cycle.
The facility's pricing structure reveals a significant gap between the Medicare benchmark and commercial rates. The Medicare reimbursement amount for this service is $32.40, which serves as a scientifically validated baseline for the true cost of care. In contrast, the median negotiated rate across payers is $74.00, and the highest negotiated rate reaches $150.00, indicating that commercial rates can exceed 200% of the Medicare benchmark. This disparity highlights the importance of understanding that in-network insurance rates are not necessarily the lowest possible prices; in some cases, paying cash or utilizing a prompt-pay discount can result in substantial savings compared to the allowed amount. Consumers are advised to request an itemized bill if they receive a summary invoice, as detailed statements are essential for identifying errors