Occupational therapy (self-care training)
Facility: Lindsborg Community Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $102
- Cash Discount Price: $82
- 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 |
|---|---|---|
| Tricare | $31 - $109 | 96% |
| Coventry Mcr Adv | $31 - $110 | 96% |
| Blue Cross Blue Shield | $34 | 105% |
| Cigna | $55 - $197 | 170% |
| UnitedHealthcare | $58 - $209 | 179% |
| Coventry Comm-All Other Plans | $58 - $209 | 179% |
| Phcs Preferred-All Plans | $60 - $216 | 185% |
| Multiplan-All Plans | $60 - $216 | 185% |
| Century Health-All Plans | $62 - $221 | 191% |
| Wppa-All Plans | $62 - $221 | 191% |
| Health Partners -All Plans | $62 - $221 | 191% |
| Coventry Wc | $62 - $221 | 191% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, Occupational therapy (self-care training), Lindsborg Community Hospital in Lindsborg, KS, has a gross charge of $117.00. The facility's cash median rate is $82.00, which is lower than the state average of $105.00. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should note that commercial insurance negotiated rates often exceed cash prices due to administrative overhead. For instance, Cigna's negotiated range spans from $55.00 to $197.00, and UnitedHealthcare's range is $58.00 to $209.00. If you have a high-deductible plan, paying the cash price of $82.00 upfront may be more cost-effective than waiting for insurance to pay a negotiated rate that could reach nearly $210.00.
To ensure you are receiving the best possible price, it is recommended to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Additionally, ask the billing department about prompt-pay discounts, which can reduce the cash price by 20% to 50% for upfront payment, bypassing the costly insurance claims cycle. While Medicare benchmarks this service at $32.40, commercial contracts often result in rates significantly higher than this federal baseline. Always verify your specific plan's deductible status and allowed amounts with the hospital prior to scheduling to avoid unexpected balance billing or out-of-pocket costs.