Occupational therapy (self-care training)
Facility: Sheridan County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $65
- Cash Discount Price: $97
- vs. Medicare Baseline: 2.01x 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 201% of the Medicare baseline (a markup of 101%). 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 | $47 | 145% |
| Celtic Insurance | $51 - $65 | 157% |
| UnitedHealthcare | $81 - $103 | 250% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service, Sheridan County Hospital in Hoxie, KS, lists a cash median price of $97.00, which matches the gross charge. This cash rate is significantly higher than the Medicare benchmark of $32.40, reflecting a markup common in commercial pricing where negotiated rates often average 200% to 300% of the federal baseline. While the facility offers a median negotiated rate of $65.00 to insurance payers like Blue Cross Blue Shield, Celtic Insurance, and UnitedHealthcare, patients should be aware that commercial rates can sometimes exceed cash prices depending on individual plan deductibles. If your insurance deductible has not been met, you may end up paying the full negotiated amount, whereas paying cash directly could result in a lower out-of-pocket cost.
To ensure you are receiving the best possible rate, it is essential to verify your specific plan's allowed amount before scheduling, as in-network rates vary by carrier and can differ substantially from other facilities. Additionally, patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts, which can reduce bills by 20% to 50% when paid in full upfront, bypassing the administrative costs associated with insurance claims. Since over 80% of hospital bills contain errors, do not accept a summary invoice as final; instead, request a detailed, itemized statement to identify any unbundled codes or services not rendered. For this service, the facility is a Government-Local owned Critical Access Hospital in Sheridan County, and while no specific county or state average data was provided in this report, comparing your final bill against the Medicare rate of $32