Occupational therapy (self-care training)
Facility: Stafford County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $54
- Cash Discount Price: $54
- vs. Medicare Baseline: 1.67x 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 |
|---|---|---|
| Health Partners-All Plans | $49 - $62 | 151% |
| Humana | $52 - $65 | 160% |
| UnitedHealthcare | $52 - $65 | 160% |
| Medica Mcr- All Plans | $52 - $65 | 160% |
| Va Ccn-All Plans | $52 - $65 | 160% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, Occupational therapy (self-care training), Stafford County Hospital in Stafford, KS, lists a cash median price of $54.00, which matches the facility's negotiated median rate. This cash price is significantly higher than the Medicare benchmark of $32.40, reflecting a markup of 1.7 times the federal rate. While the facility is a Critical Access Hospital owned by the local government, patients should be aware that commercial insurance plans often pay negotiated rates that can exceed these cash prices. For individuals with high-deductible plans, paying the cash price of $54.00 upfront may result in lower out-of-pocket costs compared to insurance reimbursement, provided the patient's deductible has not yet been met.
The data indicates that five payers, including Health Partners, Humana, UnitedHealthcare, Medica Mcr, and the VA, have negotiated rates ranging from $52.00 to $65.00, all of which are at or above the cash price. Because the cash rate is already the lowest available option in this dataset, patients should not assume that signing up for insurance will reduce their cost. To ensure you receive the best possible rate, it is recommended to explicitly ask the hospital's billing department about "self-pay" or "prompt-pay" discounts before scheduling your visit. These discounts can further reduce the bill by offering immediate liquidity incentives, but they must be requested prior to check-in to avoid automatic claims submission that would void the cash agreement.