Occupational therapy (self-care training)
Facility: Graham County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $33
- Cash Discount Price: $40
- vs. Medicare Baseline: 1.02x 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 |
|---|---|---|
| Medicare (plans) | $26 - $34 | 80% |
| UnitedHealthcare | $28 - $43 | 86% |
| Celtic Commercial-All Other Plans | $29 - $37 | 90% |
| Medicaid / KanCare | $31 | 96% |
| Wppa (Providers Care)-All Plans | $33 - $43 | 102% |
| Blue Cross Blue Shield | $34 | 105% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, Occupational therapy (self-care training), the cash price at Graham County Hospital in Hill City, KS, is $40.00. This cash rate matches the facility's own median paid amount and is identical to the Medicare benchmark of $32.40 when adjusted for the local cost basis, indicating the facility is charging at or slightly above the federal government's calculated "true cost" for this service. While commercial payers negotiate rates ranging from $26 to $43 depending on the plan, these negotiated amounts often exceed the cash price due to administrative overhead and contract structures. Patients with high-deductible plans may find paying the $40.00 cash rate directly more cost-effective than relying on insurance, which could result in a negotiated rate higher than the cash price before deductibles are met.
To minimize costs, patients should verify if the hospital offers a "prompt-pay" discount for upfront payment, which can reduce the bill by 20% to 50% by bypassing insurance processing fees. It is also important to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as double-billing or unbundled codes that can be corrected. Since this facility is a Critical Access Hospital with government local ownership, patients should confirm whether the specific service is covered under their plan and check for any "self-pay" or "cash-pay" discounts available prior to scheduling. The data provided reflects pricing for the 2026-06 vintage and does not include state or county average comparisons for this specific code.