Occupational therapy (self-care training)
Facility: Clara Barton Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $73
- Cash Discount Price: $62
- vs. Medicare Baseline: 2.25x 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 225% of the Medicare baseline (a markup of 125%). 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% |
| 6 Degrees Health - All Plans | $57 - $67 | 176% |
| Wppa-All Plans | $65 - $77 | 201% |
| Phcs - All Plans | $73 - $86 | 225% |
| Aetna | $73 - $86 | 225% |
| UnitedHealthcare | $73 - $86 | 225% |
| Hlth Partners Of Ks-All Plans | $75 - $88 | 231% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Clara Barton Hospital in Hoisington, KS, the cash price of $62.00 is lower than the facility's negotiated rates, which range from $34.00 to $88.00 depending on the insurance plan. While the cash price is significantly below the gross charge of $89.00, patients with high-deductible plans may find the cash option more affordable if their insurance negotiated rate exceeds this amount. It is important to note that while the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, the cash price does not automatically guarantee the lowest cost; patients should explicitly ask about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can further lower the final bill by bypassing administrative processing costs.
When comparing this service to broader benchmarks, the cash price of $62.00 is notably higher than the state average for this procedure, which is $34.00. However, the facility's negotiated rates for commercial payers like Blue Cross Blue Shield and UnitedHealthcare fall within a range that is generally consistent with or slightly above the state median paid amount of $74.00. Under the No Surprises Act, patients should be aware that balance billing for out-of-network services at this in-network facility is prohibited for emergency care and non-emergency services, meaning any unexpected charges beyond the allowed amount would be illegal. To ensure accuracy, patients should request a full itemized CPT-coded bill rather than accepting a summary invoice, as over 80% of hospital bills contain errors such as unbundled codes or charges for services not rendered, which