Occupational therapy (self-care training)
Facility: Via Christi Hospital Wichita St Teresa, Inc
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $31
- Cash Discount Price: Unavailable
- 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 |
|---|---|---|
| Humana | $30 | 93% |
| Saint Lukes Health Systems | $30 | 93% |
| Va | $30 | 93% |
| Medicare (plans) | $30 - $31 | 93% |
| Via Christi Research | $30 | 93% |
| Vc Hope | $30 | 93% |
| UnitedHealthcare | $31 - $85 | 96% |
| Blue Cross Blue Shield | $31 | 96% |
| Corizon | $38 | 117% |
| Smarthealth | $42 | 130% |
| Medicaid / KanCare | $51 | 157% |
| Coventry City Of Wichita | $77 | 238% |
| Aetna | $103 | 318% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, representing occupational therapy self-care training, the negotiated rates at Via Christi Hospital Wichita St Teresa, Inc. range from $30 to $103 across 13 different payers, with a median negotiated amount of $31.00. This facility is a voluntary non-profit church-owned acute care hospital located in Wichita, Kansas (ZIP 67235). While specific cash and median paid values are not disclosed in the current data, patients should be aware that cash-pay options can sometimes be more cost-effective than insurance negotiated rates, particularly for those with high-deductible plans where the insurer's allowed amount exceeds the cash price. It is always advisable to contact the hospital directly to inquire about self-pay or prompt-pay discounts, which can significantly reduce out-of-pocket costs by bypassing administrative fees associated with insurance billing cycles.
The facility's pricing is benchmarked against Medicare, which sets a fixed reimbursement rate of $32.40 for this service, indicating a ratio of 1.0 relative to the Medicare amount. This suggests that the negotiated rates align closely with the federal baseline, avoiding the typical commercial markup often seen in private insurance contracts. However, individual payer rates vary widely, with UnitedHealthcare showing a range of $31 to $85 and Aetna at a single rate of $103, highlighting the importance of verifying specific plan allowances before scheduling. Consumers are encouraged to request an itemized billing audit if they receive a summary bill, as over 80% of hospital invoices contain errors such as unbundled codes or charges for services not rendered. Additionally, under the No Surprises Act, patients are protected from