Occupational therapy (self-care training)
Facility: Ellinwood District Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $39
- Cash Discount Price: $47
- vs. Medicare Baseline: 1.20x 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 |
|---|---|---|
| Blue Cross Blue Shield | $38 | 117% |
| Humana | $38 | 117% |
| UnitedHealthcare | $38 | 117% |
| Cigna | $38 | 117% |
| Aetna | $38 | 117% |
Consumer Guidance & Cost Commentary
For CPT code 97535, Occupational therapy (self-care training), at Ellinwood District Hospital in Ellinwood, KS, the facility's cash median rate is $47.00, while the median negotiated rate paid by insurance is $39.00. This specific service is priced at $38.00 across all five major payers listed, including Blue Cross Blue Shield, Humana, UnitedHealthcare, Cigna, and Aetna. Notably, the cash price of $47.00 is higher than the negotiated rates, meaning patients with high-deductible plans or those paying out-of-pocket may find the cash rate more expensive than what their insurance would allow. However, because the negotiated rate is $39.00, which aligns with the median negotiated rate, patients should verify their specific plan's allowed amount before scheduling to ensure they are not subject to balance billing if they choose to pay cash.
The facility, a Critical Access Hospital owned by a Government Hospital District, reports a gross charge of $55.00, which is significantly higher than both the cash and negotiated rates. While the data does not provide specific state or county average comparisons for this exact code, the disparity between the gross charge and the negotiated rate highlights the importance of understanding the difference between list prices and actual billing. Patients should be aware that hospitals often offer prompt-pay discounts for upfront cash payments, which can reduce the $47.00 cash median further. Additionally, if a patient receives care from an out-of-network provider at this in-network facility, they may encounter balance billing for services not covered by the No Surprises Act protections, such as certain anc