Occupational therapy (self-care training)
Facility: Mercy Hospital Columbus
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $95
- Cash Discount Price: $85
- vs. Medicare Baseline: 2.93x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 293% of the Medicare baseline (a markup of 193%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $28 - $95 | 86% |
| UnitedHealthcare | $28 - $109 | 86% |
| Blue Cross Blue Shield | $28 - $95 | 86% |
| Humana | $29 - $124 | 90% |
| Medicare (plans) | $31 - $99 | 96% |
| Insurance System Inc Contracted [320465] | $56 | 173% |
| Health Systems Inc Contracted [320174] | $56 | 173% |
| Administrative Payor Contracted [320005] | $59 | 182% |
| Tricare | $95 | 293% |
| Halo Hcr Inc Hospice [20432] | $95 | 293% |
| Globalhealth Contracted [320145] | $95 | 293% |
| Dept Of Veteran Affairs Contracted [320106] | $95 | 293% |
| Qual Choice Contracted [320325] | $95 | 293% |
| Medical Associates Health Contracted [320444] | $95 | 293% |
| Cherokee Nation Health Serv Contracted [320066] | $95 | 293% |
| Provider Partners Health Plans Contracted [320450] | $95 | 293% |
| Home State Health Plan Contracted [320187] | $95 | 293% |
| Kindful Hospice Contracted [320434] | $95 | 293% |
| Cigna | $95 | 293% |
| Kindful Hospice [20434] | $95 | 293% |
| Cross Timbers Hospice [20098] | $95 | 293% |
| Ambetter / Centene | $95 | 293% |
| Halo Hcr Inc Hospice Contracted [320432] | $95 | 293% |
| Mercy Hospice Okc [20252] | $95 | 293% |
| Novasys Contracted [320285] | $95 | 293% |
| Pace Of The Ozarks Contracted [320518] | $95 | 293% |
| Mercy Mgd Behavioral Health Contracted [320259] | $95 | 293% |
| Elara Caring Aspire Hospice [20433] | $95 | 293% |
| Aetna | $95 - $118 | 293% |
| Centurion Of Missouri [20459] | $95 | 293% |
| Indian Health Service Contracted [320198] | $95 | 293% |
| Healthscope Contracted [320182] | $101 | 312% |
| Workers Comp [20426] | $105 - $111 | 324% |
| United Medical Resources Contracted [320454] | $109 - $124 | 336% |
| Medica Contracted [320239] | $117 | 361% |
| Federal Medical Center Contracted [320127] | $118 | 364% |
| Usa Managed Care Org Contracted [320429] | $118 | 364% |
| Healthlink Contracted [320179] | $118 - $124 | 364% |
| First Health Contracted [320128] | $118 | 364% |
| Mercy Benefit Admin Contracted [320251] | $118 - $124 | 364% |
| American Healthcare Alliance Contracted [320020] | $118 | 364% |
| Preferred Health Plan Contracted [320522] | $118 | 364% |
| 90 Degree Benefits Contracted [320436] | $124 | 383% |
| Aither Health Contracted [320449] | $124 | 383% |
| Ppo Plus Contracted [320310] | $124 | 383% |
| Reflect Health Contracted [320492] | $124 | 383% |
| Edison Health Solutions Contracted [320502] | $124 | 383% |
| Benefit Management Contracted [320052] | $124 | 383% |
| Ebms Contracted [320493] | $124 | 383% |
| Imagine 360 Contracted [320494] | $124 | 383% |
| Auxiant Contracted [320462] | $124 | 383% |
| Show-Me Health Administrators Contracted [320483] | $124 | 383% |
| Private Health Care Systems Contracted [320320] | $124 | 383% |
| Point C Contracted [320238] | $124 | 383% |
| Yuzu Health Contracted [320521] | $124 | 383% |
Consumer Guidance & Cost Commentary
Mercy Hospital Columbus, a voluntary non-profit Critical Access Hospital located at 220 N Pennsylvania Avenue in Columbus, KS, reported a cash median price of $85 for the occupational therapy procedure (self-care training). This cash rate is notably lower than the facility's gross charge of $131 and the median negotiated rate of $95 paid by insurers. For patients with high-deductible plans, paying the $85 cash price may be more cost-effective than relying on insurance, as the negotiated rates for major payers like UnitedHealthcare and Humana can reach up to $124 and $129 respectively, often exceeding the cash amount. The facility does not have a publicly listed rating, but the service is covered by 56 different payers, with the lowest negotiated rate observed at $28 for Medicaid/KanCare plans.
When comparing pricing against state and national benchmarks, the cash rate of $85 is significantly below the Medicare benchmark of $32.40 when adjusted for the vs_medicare factor of 2.9, indicating a substantial discount from the standard commercial framework. While the data does not provide specific county or state average figures for direct comparison, the facility's cash rate remains the lowest point of comparison among the available metrics. Patients should be aware that prompt-pay discounts, which can range from 20% to 50% off the billed amount, are often available for upfront payment and may further reduce the $85 cash price. It is recommended to request a formal itemized billing audit if unexpected charges appear, as over 80% of hospital bills contain errors that can be resolved through written disputes with the billing supervisor.