Occupational therapy (self-care training)
Facility: Medicine Lodge Memorial Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $64
- Cash Discount Price: $67
- vs. Medicare Baseline: 1.98x 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 |
|---|---|---|
| Tricare | $54 | 167% |
| Humana | $61 | 188% |
| Aetna | $62 - $67 | 191% |
| Hpk-All Plans | $64 | 198% |
| UnitedHealthcare | $64 | 198% |
| Medicaid / KanCare | $67 | 207% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Medicine Lodge Memorial Hospital in Medicine Lodge, KS, the cash price is $67.00, which matches the facility's negotiated rate and the highest amount paid by any insurer in this dataset. This cash price is significantly higher than the state average, as indicated by a 2.0x markup compared to Medicare's benchmark rate of $32.40. While commercial insurance plans like Aetna and Humana negotiate rates ranging from $61 to $67, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying the full $67.00 upfront rather than relying on insurance reimbursement.
Patients should verify their specific plan details before scheduling, as commercial rates can vary widely even within the same network. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to request a prompt-pay discount or self-pay rate before check-in to ensure the facility does not submit a claim to your insurance that could void any cash savings. If you receive a bill, always demand a full itemized statement to review every CPT code and unit charge, as over 80% of hospital bills contain errors such as unbundled services or charges for items not rendered. Comparing your final allowed amount to the Medicare benchmark of $32.40 provides a clear view of the facility's pricing structure relative to federal cost standards.