Occupational therapy (self-care training)
Facility: Minneola District Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $45
- Cash Discount Price: $35
- vs. Medicare Baseline: 1.39x 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 | $34 - $50 | 105% |
| Va Community Care Program-All Plans | $34 | 105% |
| Blue Cross Blue Shield | $34 | 105% |
| Humana | $34 | 105% |
| Corporate Plan Management-All Plans | $42 | 130% |
| Providrs Care Network-All Plans | $42 | 130% |
| Preferred Health Care (Coventry)-All Other Plans | $45 | 139% |
| Triwest-All Plans | $45 | 139% |
| Phc (Coventry) Leased Network | $48 | 148% |
| Health Partners Of Kansas-All Plans | $48 | 148% |
| Aetna | $48 - $50 | 148% |
| Medicaid / KanCare | $50 | 154% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, Occupational therapy (self-care training), the facility's cash median rate is $35.00, which is lower than the negotiated rates paid by most insurance plans. While the facility's cash price is $35.00, the median negotiated rate across payers is $45.00, meaning patients with high-deductible plans might save money by paying the cash price directly, provided they have not met their deductible. It is important to note that while the facility is a Critical Access Hospital in Minneola, KS, the data does not include specific state or county average comparisons for this service, so patients should verify local pricing trends independently.
The Medicare benchmark for this service is $32.40, and the facility's cash rate of $35.00 is slightly above this federal baseline, indicating a pricing structure that is competitive relative to the government's cost basis. Although the facility is owned by a Government Hospital District, the data shows no specific facility rating. Patients should be aware that while the No Surprises Act protects against balance billing for out-of-network providers at in-network facilities, they should still request an itemized bill to ensure no unbundled charges or services not rendered are included. Finally, patients should explicitly ask the billing department about "prompt-pay" discounts before scheduling, as paying in full upfront can often reduce the final amount owed.