Occupational therapy (self-care training)
Facility: Kansas Medical Center Llc
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $31
- Cash Discount Price: $42
- vs. Medicare Baseline: 0.96x 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 |
|---|---|---|
| Medicaid / KanCare | $19 | 59% |
| Tricare | $27 | 83% |
| Wppa | $28 | 86% |
| Indian Health | $28 | 86% |
| Blue Cross Blue Shield | $31 - $33 | 96% |
| Medadv_Wellcare | $31 | 96% |
| Ambetter / Centene | $31 | 96% |
| Humana | $31 | 96% |
| Three_Rivers | $61 | 188% |
| Aetna | $67 | 207% |
| United | $71 | 219% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at Kansas Medical Center Llc in Andover, the negotiated rates range from $19 to $71, with a median paid amount of $51.00. This median paid rate is significantly higher than the facility's cash price of $42.00, illustrating that insurance coverage often results in higher out-of-pocket costs for patients due to administrative fees and contract structures. While the facility's negotiated rate of $31.00 is lower than the gross charge of $71.00, it remains above the state average for this procedure, indicating that the commercial pricing structure includes substantial markups beyond the true cost of care.
Patients should be aware that balance billing can occur if they receive care from out-of-network providers, where the hospital bills the difference between the full chargemaster rate and the insurance allowed amount. However, the No Surprises Act protects patients from these surprise bills for emergency and non-emergency services at in-network facilities. To minimize costs, consumers should request an itemized billing audit to identify any unbundled codes or services not rendered, as over 80% of hospital bills contain errors. Additionally, asking for a prompt-pay discount before scheduling can reduce the bill by 20% to 50%, offering a more affordable option than relying on insurance negotiations.