Occupational therapy (self-care training)
Facility: Rooks County Health Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $93
- Cash Discount Price: $78
- vs. Medicare Baseline: 2.87x 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 287% of the Medicare baseline (a markup of 187%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $34 | 105% |
| Celtic Mcr Adv | $49 | 151% |
| Veterans Admin - All Plans | $49 | 151% |
| Tricare | $49 | 151% |
| Celtic Comm - All Other Plans | $54 | 167% |
| Aetna | $93 | 287% |
| UnitedHealthcare | $93 | 287% |
| Preferred Benefits Admin | $93 | 287% |
| Health Partners - All Plans | $98 | 302% |
| Preferred Hlthcare - All Other Plans | $98 | 302% |
| Healthy Blue Mcaid - All Plans | $104 | 321% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service (CPT 97535) at Rooks County Health Center in Plainville, KS, the facility's cash price of $78.00 is notably lower than the state average of $93.00. While the facility's negotiated rates with commercial payers like Aetna and UnitedHealthcare are set at $93.00, this amount exceeds the cash price, meaning patients with high-deductible plans or those seeking immediate payment may find the cash rate more cost-effective. It is important to note that the facility is a Critical Access Hospital owned by a Government Hospital District, and while the cash rate is lower than the state median, the negotiated rates reflect the administrative costs and contract structures typical of in-network care.
When evaluating the cost of this service, it is crucial to understand that the facility's gross charge of $104.00 is significantly higher than the Medicare benchmark of $32.40, illustrating a common markup in commercial billing. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, patients should still verify their specific plan details before scheduling. To potentially reduce costs further, consumers should contact the billing department directly to inquire about "self-pay" or "prompt-pay" discounts, which can offer immediate fee reductions for upfront payments. Always request an itemized bill to ensure all charges are accurate and to identify any potential errors before finalizing payment.