Occupational therapy (self-care training)
Facility: Hamilton County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $45
- Cash Discount Price: $50
- vs. Medicare Baseline: 1.39x 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 | $16 - $34 | 49% |
| First Health Coventry - All Plans | $42 | 130% |
| UnitedHealthcare | $48 | 148% |
| Cigna | $48 | 148% |
| Va Ccn - All Plans | $50 | 154% |
| Aetna | $85 | 262% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at Hamilton County Hospital in Syracuse, KS, the cash price of $50.00 is the most transparent baseline for patients. While the facility's negotiated rates with major payers like Blue Cross Blue Shield range from $16 to $48, and the median negotiated amount across all six payers is $45.00, the cash price remains consistent at $50.00. It is important to note that for patients with high-deductible plans, paying the cash price of $50.00 upfront can sometimes be cheaper than the insurance negotiated rate, which may exceed the cash amount once deductibles and copays are applied. Additionally, patients should explicitly ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing costly claims processing and administrative overhead.
When evaluating the value of this service, it is helpful to compare the facility's pricing against the Medicare benchmark, which stands at $32.40 for this code. The facility's cash price of $50.00 represents a 1.4x markup relative to the Medicare rate, which is a common pricing structure for Critical Access Hospitals. While the facility is owned by the local government, the specific negotiated rates vary significantly by insurer, with UnitedHealthcare and Cigna paying the full $48.00, whereas Blue Cross Blue Shield plans range from $16 to $42. Patients should avoid accepting summary bills and instead request a detailed, itemized statement to ensure no unbundled codes or services not rendered are included