Occupational therapy (self-care training)
Facility: Republic County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $71
- Cash Discount Price: $58
- vs. Medicare Baseline: 2.19x 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 219% of the Medicare baseline (a markup of 119%). 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 |
|---|---|---|
| Rural Carriers-All Plans | $65 | 201% |
| Meritain-All Plans | $69 | 213% |
| Aetna | $69 | 213% |
| UnitedHealthcare | $71 | 219% |
| First Health-All Plans | $73 | 225% |
| Midlands Choice-All Plans | $73 | 225% |
| Cigna | $73 | 225% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Republic County Hospital in Belleville, KS, the cash price of $58.00 is lower than the facility's negotiated rate of $71.00. This cash rate is also below the state of Kansas average, suggesting that paying out-of-pocket may be the most cost-effective option for patients with high-deductible plans or those without insurance. While the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, patients should verify if "self-pay" or "prompt-pay" discounts are available before scheduling, as these upfront incentives can further reduce the final bill by bypassing administrative claim processing fees.
The Medicare benchmark for this procedure is $32.40, which serves as the objective baseline for evaluating pricing markups. Although the facility's gross charge is $77.00, commercial payers negotiate rates ranging from $65.00 to $73.00, all of which exceed the cash price. Because commercial rates often include administrative overhead and contract ceilings, the cash price of $58.00 represents a significant savings compared to the median negotiated payment of $71.00. Patients should request an itemized bill to ensure no unbundled codes or services not rendered are included, and they should avoid paying balance bills immediately if they suspect errors, as federal protections exist for out-of-network care at in-network facilities.