Occupational therapy (self-care training)
Facility: Holton Community Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $47
- Cash Discount Price: $42
- vs. Medicare Baseline: 1.45x 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 |
|---|---|---|
| Aetna | $27 - $60 | 83% |
| Humana | $27 - $32 | 83% |
| UnitedHealthcare | $27 - $100 | 83% |
| Kansas Superior Select - All Plans | $28 - $32 | 86% |
| Blue Cross Blue Shield | $34 | 105% |
| Preferred Health Freedom | $42 - $50 | 130% |
| Preferred Health Professionals | $42 - $50 | 130% |
| Preferred Health Fn Select - All Other Plans | $42 - $50 | 130% |
| Wppa Providers - All Plans | $48 - $57 | 148% |
| Medicaid / KanCare | $51 - $60 | 157% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, Occupational therapy (self-care training), Holton Community Hospital in Holton, KS, has a cash median price of $42.00, which is lower than the facility's negotiated average of $47.00. This cash rate is also notably lower than the Medicare benchmark of $32.40 when adjusted for the facility's specific markup context, though the direct comparison shows the cash price exceeds the base Medicare amount. Patients with high-deductible plans may find paying the $42.00 cash rate more advantageous than using insurance, as commercial negotiated rates for this service range from $27 to $100 across ten payers, with some plans potentially exceeding the cash price. It is important to note that while the facility is a Voluntary non-profit Critical Access Hospital, the cash rate remains a competitive option compared to the wide variance in insurance allowed amounts.
To ensure you are not overcharged, we recommend requesting an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you choose to use insurance, be aware that while the facility is in-network for ten payers, the negotiated rates vary significantly, with UnitedHealthcare plans potentially allowing up to $100 and Medicaid/KanCare plans allowing up to $33. Additionally, you should inquire about prompt-pay discounts, which can reduce the cash price by 20% to 50% if paid upfront, bypassing the administrative costs associated with insurance claims processing. Always verify your deductible status before scheduling, as paying the negotiated rate without meeting your deductible could result