Occupational therapy (self-care training)
Facility: Osborne County Memorial Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $54
- Cash Discount Price: $51
- vs. Medicare Baseline: 1.67x 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 |
|---|---|---|
| UnitedHealthcare | $45 - $46 | 139% |
| Health Partners Of Kansas | $51 - $52 | 157% |
| Wppa | $56 - $57 | 173% |
| Blue Cross Blue Shield | $58 - $59 | 179% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Osborne County Memorial Hospital, the cash price of $51.00 is notably lower than the facility's negotiated rates, which range from $45.00 to $59.00 depending on the insurance carrier. While commercial payers like UnitedHealthcare and Blue Cross Blue Shield typically pay between $45.00 and $59.00, the cash price of $51.00 represents a significant discount compared to these negotiated amounts. This pricing structure aligns closely with the state of Kansas average, where cash payments often provide a more economical option for patients with high-deductible plans who have not yet met their out-of-pocket thresholds.
The facility's negotiated rates are approximately 1.7 times higher than the Medicare benchmark of $32.40, indicating a substantial markup relative to the federal baseline. Patients should be aware that while in-network insurance offers protection against balance billing, the actual amount paid by the insurer may still exceed the cash price due to administrative costs and contract dynamics. To maximize savings, it is advisable to contact the hospital directly to confirm "self-pay" or "prompt-pay" discounts, which can further reduce the final cost. Additionally, requesting a detailed itemized bill before payment allows you to verify that no unbundled codes or services not rendered have inflated the total charge.