Occupational therapy (self-care training)
Facility: Satanta District Hospital, Clinics, & Ltcu
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $38
- Cash Discount Price: $48
- vs. Medicare Baseline: 1.17x 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 |
|---|---|---|
| Direct Benefit-All Plans | $13 | 40% |
| UnitedHealthcare | $15 - $53 | 46% |
| Berkley Net-All Plans | $21 | 65% |
| Aetna | $23 - $36 | 71% |
| Trustmark Health Benefits-All Plans | $23 | 71% |
| Meritain Health-All Plans | $24 | 74% |
| Ambetter / Centene | $25 | 77% |
| Axa Equitable - All Plans | $29 | 90% |
| Medi-Share-All Plans | $30 | 93% |
| Pinnacol-All Plans | $30 | 93% |
| Presbyterian-All Plans | $32 | 99% |
| Kasb Work Comp - All Plans | $34 | 105% |
| The Kempton Group Admin-All Plans | $37 | 114% |
| Gpha(Wppa)-All Other Plans | $37 | 114% |
| Auxiant - All Plans | $37 | 114% |
| Sisco-All Plans | $38 | 117% |
| Providers Care Network- All Plans | $38 | 117% |
| Emc-All Plans | $38 | 117% |
| Wppa- All Plans | $38 | 117% |
| Gpha Employee Benefit Plan | $39 | 120% |
| Employee Benefit-All Plans | $40 | 123% |
| Regional Care(Wppa)-All Plans | $40 | 123% |
| Triangle-All Plans | $40 | 123% |
| First Health -All Plans | $40 | 123% |
| One Call Physician-All Plans | $41 | 127% |
| Tricare | $42 | 130% |
| Blue Cross Blue Shield | $42 | 130% |
| Christian Hospital Aid - All Plans | $42 | 130% |
| Humana | $46 | 142% |
| Luminare Health- All Plans | $47 | 145% |
| Cigna | $47 | 145% |
| Coresource-All Plans | $48 | 148% |
| Deseret Mutual(Uhis)-All Plans | $48 | 148% |
| Vaccn-All Plans | $49 | 151% |
| Hma Llc-All Plans | $50 | 154% |
| Wps Vapc-All Plans | $50 | 154% |
| Reserve National-All Plans | $50 | 154% |
| Medicaid / KanCare | $53 | 164% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Satanta District Hospital, the cash price of $48.00 is slightly lower than the facility's negotiated rate of $38.00, which aligns with the state of Kansas average. While many commercial payers negotiate rates ranging from $13 to $53, the cash price remains competitive and may be more cost-effective for patients with high-deductible plans who have not yet met their out-of-pocket maximum. To maximize savings, patients should explicitly request "self-pay" or "prompt-pay" discounts before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
When comparing this service to the national benchmark, the facility's cash rate is 1.2 times the Medicare amount of $32.40, indicating a moderate markup relative to the federal baseline. It is important to note that while the facility is a Critical Access Hospital in Satanta, KS, and is government-owned, the negotiated rates for commercial insurers often exceed the cash price due to the administrative costs of claims management. Patients should avoid accepting summary bills and instead request a full itemized statement to verify that no unbundled codes or services not rendered have inflated the total, ensuring they are only paying for the actual care received.