Occupational therapy (self-care training)
Facility: Decatur Health
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $102
- Cash Discount Price: $120
- vs. Medicare Baseline: 3.15x 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 315% of the Medicare baseline (a markup of 215%). 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 | $44 | 136% |
| Wppa/Providrs Care- All Plans | $80 | 247% |
| UnitedHealthcare | $81 - $102 | 250% |
| Humana | $82 | 253% |
| Aetna | $120 - $133 | 370% |
| Midlands Choice- All Plans | $120 | 370% |
| Medicaid / KanCare | $135 | 417% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Decatur Health in Oberlin, Kansas, the cash median price is $120.00, which is lower than the facility's negotiated rates with major payers like UnitedHealthcare ($81–$102) and Aetna ($120–$133). While the cash price is competitive, patients with high-deductible plans may find that paying out-of-pocket is more cost-effective than relying on insurance, as the negotiated amounts often exceed the cash rate. It is important to note that the facility's cash price is significantly higher than the Medicare benchmark of $32.40, illustrating how commercial rates can be marked up well above the federal baseline.
The data indicates that while the facility has a median negotiated payment of $92.00 across payers, the actual cash price of $120.00 suggests that self-pay patients might face higher costs than the average insurance reimbursement. Patients should proactively ask the hospital about "self-pay" or "prompt-pay" discounts before scheduling, as these upfront fee reductions can bypass the administrative overhead of insurance billing. Additionally, if a patient receives a bill from an out-of-network provider at this facility, they should be aware of the No Surprises Act protections, which prevent balance billing for emergency and non-emergency services, and should request a formal itemized audit if they suspect errors or unbundled charges on their statement.