Occupational therapy (self-care training)
Facility: Cheyenne County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $56
- Cash Discount Price: $59
- vs. Medicare Baseline: 1.73x 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 | $34 | 105% |
| First Health - All Plans | $41 | 127% |
| UnitedHealthcare | $42 - $230 | 130% |
| Tricare | $42 | 130% |
| Aetna | $42 - $56 | 130% |
| Healthy Blue Mcr Adv | $42 | 130% |
| Choice Care - All Plans | $43 | 133% |
| Firstguard - All Plans | $47 | 145% |
| Wppa - All Plans | $53 | 164% |
| Cpm - All Plans | $56 | 173% |
| Preferred Hc - All Plans | $56 | 173% |
| Midlands Choice - All Plans | $57 | 176% |
| Unicare - All Plans | $58 | 179% |
| Ppo Next - All Plans | $58 | 179% |
| Health Partners - All Plans | $58 | 179% |
| Integrated Hp - All Plans | $58 | 179% |
| Healthy Blue Mcaid - All Other Plans | $59 | 182% |
| Healthwave Mcaid - All Plans | $59 | 182% |
| Childrens Mercy - All Plans | $59 | 182% |
| Providers Care-All Plans | $88 | 272% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at Cheyenne County Hospital, the cash price is $59.00, which matches the facility's negotiated rate of $56.00 and the state average of $59.00. While many payers have negotiated rates ranging from $34 to $88, the cash price is notably lower than the highest negotiated rates found among UnitedHealthcare and Providers Care-All Plans. Because commercial insurance negotiated rates often include administrative overhead and claim processing costs, paying cash upfront can sometimes result in a lower total cost for patients with high-deductible plans, provided they secure a prompt-pay discount before the claim is submitted.
Patients should verify their specific plan details and ask the hospital directly about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full within 30 days. It is important to note that while the Medicare benchmark for this service is $32.40, the facility's cash rate of $59.00 exceeds this federal baseline, reflecting the local cost structure and wage index for this Critical Access Hospital in St Francis, KS. To ensure you are receiving the most accurate pricing, always request an itemized bill before payment and avoid signing any waivers that might void your right to negotiate or dispute charges.