Occupational therapy (self-care training)
Facility: Great Plains Of Sabetha
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $47
- Cash Discount Price: $66
- vs. Medicare Baseline: 1.45x 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 |
|---|---|---|
| Celtic Mcr Adv | $24 - $44 | 74% |
| Aetna | $25 - $86 | 77% |
| Celtic Comm Exchange-All Other Plans | $31 - $55 | 96% |
| Great West Healthcare-All Plans | $40 - $72 | 123% |
| UnitedHealthcare | $44 - $85 | 136% |
| Cigna | $45 - $81 | 139% |
| Humana | $45 - $81 | 139% |
| Multiplan-Phcs-All Plans | $45 - $81 | 139% |
| Century/Wppa/Providers-All Plans | $45 - $81 | 139% |
| Federated Mutual Ins-All Plans | $45 - $82 | 139% |
| Medicaid / KanCare | $47 - $85 | 145% |
| Blue Cross Blue Shield | $47 - $85 | 145% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at Great Plains Of Sabetha in Sabetha, KS, the cash price is $66.00, which matches the facility's cash median. While the facility's negotiated rates with major payers like Aetna and UnitedHealthcare range from $25 to $86, the cash price can sometimes be more affordable for patients with high-deductible plans if their insurance allowed amount exceeds $66.00. It is important to note that the facility's negotiated rates are significantly higher than the Medicare benchmark of $32.40, reflecting the administrative costs and contract structures inherent in commercial insurance billing.
Patients should be aware that while the No Surprises Act protects against balance billing for emergency care and non-emergency services from out-of-network providers at in-network facilities, unexpected charges can still occur if ancillary services are billed separately. To minimize costs, consumers should request a full itemized bill to verify that no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors. Additionally, patients should proactively ask about "prompt-pay" discounts or self-pay rates before scheduling, as paying upfront can often bypass the administrative overhead of insurance claims processing and result in a lower final amount than the standard negotiated rate.