Occupational therapy (self-care training)
Facility: Logan County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $95
- Cash Discount Price: $25
- vs. Medicare Baseline: 2.93x 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 293% of the Medicare baseline (a markup of 193%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
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 | $34 | 105% |
| Humana | $42 - $64 | 130% |
| Health Partners - All Plans | $95 - $142 | 293% |
| Medicaid / KanCare | $100 - $150 | 309% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Logan County Hospital in Oakley, Kansas, the cash price of $25.00 is significantly lower than the facility's negotiated rates with major payers, which range from $34 to $150 depending on the insurance plan. This disparity highlights the potential for savings for patients with high-deductible plans or those paying out-of-pocket, as the cash price is well below the median negotiated amount of $95.00. While the facility is a Critical Access Hospital owned by the local government, patients should verify their specific plan's allowed amount before scheduling, as some commercial rates can exceed the cash price. It is advisable to contact the hospital directly to confirm if "self-pay" or "prompt-pay" discounts are available, as these upfront payment incentives can further reduce the final cost.
The Medicare benchmark for this service is $32.40, which serves as a reliable baseline for evaluating the facility's pricing structure. Although the cash price of $25.00 is lower than the Medicare rate, the negotiated rates for in-network insurance are substantially higher, averaging 2.9 times the Medicare amount. This pricing dynamic underscores the importance of understanding that commercial insurance contracts often include administrative overhead that inflates the baseline price compared to the federal government's cost-based reimbursement. Consumers should be aware that while the No Surprises Act protects against balance billing for emergency care at in-network facilities, it is crucial to request an itemized bill to ensure no unbundled codes or services not rendered are included in the final invoice.