Occupational therapy (self-care training)
Facility: Ashland Health Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $34
- Cash Discount Price: $27
- vs. Medicare Baseline: 1.05x 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 | $11 | 34% |
| Compalliance-All Plans | $27 | 83% |
| Health Partners Of Kansas-All Plans | $29 | 90% |
| Multiplan-All Plans | $33 | 102% |
| Medicaid / KanCare | $34 | 105% |
| Healthy Blue Mcr Adv - All Other Plans | $34 | 105% |
| UnitedHealthcare | $34 | 105% |
| Medicare (plans) | $34 | 105% |
| Medica Mcare - All Plans | $34 | 105% |
| Aetna | $34 | 105% |
| Health Choice-All Plans | $34 | 105% |
| Providers Care (Wppa)-All Plans | $51 | 157% |
Consumer Guidance & Cost Commentary
For CPT code 97535, Occupational therapy (self-care training), Ashland Health Center in Ashland, KS, has a gross charge of $34.00. This amount aligns with the median negotiated rate of $34.00 across 12 payers, including Blue Cross Blue Shield, UnitedHealthcare, and Medicaid/KanCare. The facility's cash median price is $27.00, which is lower than the negotiated rates. While the data does not provide specific county or state average comparisons for this code, patients should note that cash-paying can sometimes be more cost-effective than using insurance, particularly if the patient's deductible has not yet been met or if the insurance negotiated rate exceeds the cash price.
The Medicare benchmark for this service is $32.40, which serves as a baseline for evaluating pricing fairness. Although the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the gross charge of $34.00 is slightly higher than the Medicare amount. Consumers should be aware of the "prompt-pay" discount option, which may reduce the bill further if paid in full upfront, bypassing the administrative costs associated with insurance claims processing. It is also important to request an itemized billing audit if you receive a summary bill, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered. Finally, if you encounter a balance bill from an out-of-network provider at this facility, you may be protected under the No Surprises Act, which bans balance billing for emergency and non-emergency services at in-network facilities.