Occupational therapy (self-care training)
Facility: Trego County Lemke Memorial Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $47
- Cash Discount Price: $51
- vs. Medicare Baseline: 1.45x 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 |
|---|---|---|
| Humana | $29 | 90% |
| Tricare | $32 | 99% |
| Medicaid / KanCare | $37 - $60 | 114% |
| Aetna | $37 - $54 | 114% |
| UnitedHealthcare | $37 - $60 | 114% |
| Va Ccn - All Plans | $37 | 114% |
| Ambetter / Centene | $41 | 127% |
| Blue Cross Blue Shield | $47 | 145% |
| Health Partners - All Plans | $57 | 176% |
| Healthy Blue Mcaid - All Plans | $60 | 185% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Trego County Lemke Memorial Hospital, the cash price of $51.00 is notably higher than the facility's negotiated rate of $47.00 and the state of Kansas average of $37.00. While commercial insurance plans like Humana and Tricare pay a fixed $29.00 and $32.00 respectively, other payers such as Medicaid/KanCare and UnitedHealthcare have negotiated ranges that can reach up to $60.00. This variation highlights that being in-network does not guarantee the lowest possible cost, as some commercial contracts exceed the facility's cash price. Patients with high-deductible plans may find it financially advantageous to pay the $51.00 cash rate directly, potentially avoiding the higher administrative costs and negotiated fees associated with insurance claims processing.
To secure the most favorable payment, patients should proactively contact the hospital to confirm if "self-pay" or "prompt-pay" discounts are available before scheduling care, as these upfront incentives can significantly reduce the final bill. It is also important to note that the facility, a Critical Access Hospital in Wakeeney, KS, bills at a markup of 1.5 times the Medicare rate of $32.40, which serves as the objective baseline for fair pricing. Given that over 80% of hospital bills often contain errors, consumers are encouraged to request a detailed, itemized statement to verify that all charges align with the negotiated or cash rates listed above, rather than accepting summary invoices that may obscure individual costs.