Occupational therapy (self-care training)
Facility: Greenwood County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $56
- Cash Discount Price: $56
- vs. Medicare Baseline: 1.73x 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 |
|---|---|---|
| Triwest - All Plans | $24 - $26 | 74% |
| UnitedHealthcare | $28 - $62 | 86% |
| Tricare | $28 - $31 | 86% |
| Choicecare Mcr Adv - All Plans | $28 - $31 | 86% |
| Blue Cross Blue Shield | $32 - $34 | 99% |
| Integrated Health Plan - All Plans | $50 - $56 | 154% |
| Beech Street - All Plans | $56 - $63 | 173% |
| First Health Ccn Network | $56 - $63 | 173% |
| First Health - All Other Plans | $56 - $63 | 173% |
| Preferred Hs (Coventry) - All Plans | $59 - $67 | 182% |
| Principal Health Care Inc - All Plans | $63 - $70 | 194% |
| Medicaid / KanCare | $66 - $74 | 204% |
| Amerigroup Mcaid-All Plans | $66 - $74 | 204% |
| Providrs Care/Wppa - All Plans | $99 - $111 | 306% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Greenwood County Hospital in Eureka, KS, the cash and negotiated rates are both $56.00, which is significantly lower than the gross charge of $70.00. This facility, a Critical Access Hospital owned by the local government, offers a cash price that is 1.7 times the Medicare benchmark of $32.40. While the negotiated rates for various payers range from $24 to $111, the cash price of $56.00 represents a substantial discount compared to the highest negotiated amounts, such as the $99 to $111 range for Providrs Care/Wppa. Patients with high-deductible plans may find this cash rate advantageous if their insurance negotiated rates exceed $56.00, as paying upfront can bypass the administrative overhead and potential balance billing associated with insurance claims.
To maximize savings, patients should proactively request "self-pay" or "prompt-pay" discounts before scheduling their visit, as billing systems often default to insurance processing once a card is on file. Although the No Surprises Act protects patients from balance billing for out-of-network services at in-network facilities, it is crucial to verify your specific plan's allowed amount before treatment, as some in-network contracts may still result in higher costs than the cash rate. If you receive an itemized bill, review it line-by-line to ensure no unbundled codes or services not rendered are included, as over 80% of hospital bills contain errors that can be corrected through a formal written audit dispute.