Occupational therapy (self-care training)
Facility: Stanton County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $105
- Cash Discount Price: $110
- vs. Medicare Baseline: 3.24x 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 324% of the Medicare baseline (a markup of 224%). 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 | $32 - $105 | 99% |
| Healthy Blue Mcr Adv - All Other Plans | $108 | 333% |
| Healthy Blue Mcaid | $110 | 340% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at Stanton County Hospital, the cash price is $110.00, which matches the facility's negotiated rate with Healthy Blue Mcaid and the high-end range for Blue Cross Blue Shield. While the median amount paid by insurers is $106.00, patients with high-deductible plans may find paying the full cash price of $110.00 more cost-effective than relying on insurance, as the negotiated rates for some payers exceed the cash amount. It is important to note that while the facility is a Critical Access Hospital in Johnson, KS, the data does not provide specific county or state average benchmarks for this procedure, so direct comparisons to regional pricing are not available in this report.
The Medicare benchmark for this service is $32.40, which serves as a baseline to evaluate the facility's pricing markup. The commercial negotiated rate of $105.00 is significantly higher than the Medicare amount, reflecting the administrative costs and contract structures inherent in commercial insurance. Patients should be aware that balance billing is generally prohibited for out-of-network services at in-network facilities under the No Surprises Act, but it is crucial to request a full itemized bill to ensure no unbundled codes or services not rendered are included. Additionally, patients should explicitly ask the hospital about prompt-pay discounts before scheduling, as paying upfront can sometimes reduce the final cost, though the current data indicates the cash price aligns with the highest negotiated rates available.