Occupational therapy (self-care training)
Facility: Wilson Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $90
- Cash Discount Price: $84
- vs. Medicare Baseline: 2.78x 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 278% of the Medicare baseline (a markup of 178%). 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 | $34 - $112 | 105% |
| Humana | $59 | 182% |
| UnitedHealthcare | $59 - $104 | 182% |
| Tricare | $59 | 182% |
| Aetna | $59 - $112 | 182% |
| Ambetter / Centene | $59 - $112 | 182% |
| Cigna | $90 | 278% |
| Mulitplan-All Plans | $103 | 318% |
| Health Partners-All Plans | $103 | 318% |
Consumer Guidance & Cost Commentary
For CPT code 97535, Occupational therapy (self-care training), Wilson Medical Center in Neodesha, KS, has a cash price of $84.00 and a median negotiated rate of $90.00 across nine payers. While the facility's cash price is lower than the gross charge of $112.00, it is important to note that commercial insurance rates often exceed cash prices due to administrative overhead and contract structures. In this case, the median negotiated rate of $90.00 is higher than the cash price, meaning patients with high-deductible plans might save money by paying the cash price directly, provided they qualify for a self-pay or prompt-pay discount. The facility, a Critical Access Hospital owned by the local government, lists a cash median of $84.00, which serves as a baseline for those seeking to minimize out-of-pocket costs before insurance processing begins.
When evaluating the cost of this service, it is crucial to compare rates against the Medicare benchmark rather than the facility's gross charges. The Medicare amount for this code is $32.40, and the facility's cash price of $84.00 represents a markup relative to this federal baseline. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, unexpected ancillary services or emergency care could still trigger additional charges if not properly managed. To ensure transparency and avoid surprise bills, consumers should request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, verifying your deductible status and