Occupational therapy (self-care training)
Facility: Kiowa County Memorial Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $71
- Cash Discount Price: $68
- vs. Medicare Baseline: 2.19x 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 219% of the Medicare baseline (a markup of 119%). 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 - $71 | 105% |
| UnitedHealthcare | $64 - $80 | 198% |
| Health Partners Of Ks-All Plans | $70 | 216% |
| Aetna | $71 | 219% |
| Humana | $71 | 219% |
| Medica Prime Mcare Cost-All Plans | $71 | 219% |
| Celtic Comml Exchange-All Other Plans | $71 | 219% |
| Medicaid / KanCare | $80 | 247% |
| Providrs Care/Wppa-All Plans | $120 | 370% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Kiowa County Memorial Hospital in Greensburg, KS, the cash price of $68.00 is lower than the facility's median negotiated rate of $71.00. While the facility is a Critical Access Hospital owned by the local government, patients with high-deductible plans may find paying cash directly more cost-effective than relying on insurance, as the negotiated rates for payers like UnitedHealthcare and Blue Cross Blue Shield range from $64.00 to $80.00. Because the cash price is already below the average negotiated amount, there is no immediate financial incentive to use insurance for this specific service, though patients should still verify their specific plan's deductible status and out-of-pocket maximums before scheduling.
To ensure you are not overcharged, it is important to request a full itemized bill rather than accepting a summary invoice, as hospitals often bundle charges or include services not rendered. If you receive a balance bill for the difference between the provider's chargemaster and your insurance allowed amount, remember that the No Surprises Act protects you from these unexpected costs for emergency care and non-emergency services at in-network facilities. Additionally, if you choose to pay out-of-network, you may be eligible for a prompt-pay discount by paying the full amount upfront, which can reduce the total cost by 20% to 50% by bypassing the administrative costs associated with insurance claims processing.