Occupational therapy (self-care training)
Facility: Wichita County Health Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $61
- Cash Discount Price: $54
- vs. Medicare Baseline: 1.88x 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 | $48 - $64 | 148% |
| UnitedHealthcare | $58 - $77 | 179% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service, the facility's cash median rate of $54.00 is notably lower than the state average of $56.00, making it a cost-effective option for self-pay patients. While the facility's negotiated rates with UnitedHealthcare range from $58.00 to $77.00 and Medicaid/KanCare rates range from $48.00 to $64.00, these amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans should consider paying cash directly, as the $54.00 rate avoids the multi-layered billing processes that typically inflate commercial rates by 20% to 40%. It is advisable to contact the facility directly to confirm if "self-pay" or "prompt-pay" discounts are available, as paying upfront can sometimes bypass standard insurance billing cycles and reduce the final amount owed.
When evaluating this $68.00 gross charge, it is important to compare it against the Medicare benchmark of $32.40 rather than the hospital's list price, which often inflates perceived savings. The facility's negotiated rates average 1.9 times the Medicare amount, which aligns with fair pricing standards of 120% to 150% of the federal baseline, whereas commercial rates frequently reach 200% to 300% of this benchmark. Since the facility is a Critical Access Hospital in Leoti, KS, and is owned by the local government, patients should request an itemized bill to ensure no unbundled codes or services not rendered are included. If a balance bill arises from