Occupational therapy (self-care training)
Facility: Stevens County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $72
- Cash Discount Price: $83
- vs. Medicare Baseline: 2.22x 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 222% of the Medicare baseline (a markup of 122%). 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 |
|---|---|---|
| Humana | $31 | 96% |
| Aetna | $32 - $83 | 99% |
| Blue Cross Blue Shield | $32 - $34 | 99% |
| First Health - All Plans | $75 | 231% |
| Wppa - All Plans | $79 | 244% |
| Medicaid / KanCare | $83 | 256% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Stevens County Hospital in Hugoton, Kansas, the cash price is $83.00, which matches the facility's negotiated rate for Medicaid and the gross charge. This cash price is significantly higher than the state average of $72.00, though it aligns closely with the county average for this procedure. While commercial payers like Aetna and Blue Cross Blue Shield negotiate rates ranging from $32 to $83 depending on the specific plan, patients with high-deductible plans may find paying the full cash price of $83.00 upfront to be more cost-effective than relying on insurance, as the insurer's allowed amount often exceeds the cash rate. To maximize savings, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as these upfront payment incentives can reduce the final bill by 20% to 50% by bypassing administrative claim processing fees.
The facility's negotiated rate of $72.00 serves as the baseline for most insurance payments, which is lower than the gross charge but still higher than the cash price. It is important to note that while the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, unexpected charges can still occur if ancillary services like emergency care or specific lab tests are provided by out-of-network providers. To avoid these surprises, patients should review their itemized bill line-by-line to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. When evaluating the cost, comparing the commercial negotiated rate of $72.00 to the Medicare benchmark