Occupational therapy (self-care training)
Facility: Goodland Regional Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $76
- Cash Discount Price: $76
- vs. Medicare Baseline: 2.35x 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 235% of the Medicare baseline (a markup of 135%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $34 | 105% |
| Wppa | $71 - $76 | 219% |
| UnitedHealthcare | $76 | 235% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, representing occupational therapy (self-care training), the Goodland Regional Medical Center in Goodland, KS, lists a cash median price of $76.00 and a median negotiated rate of $76.00. This cash price is notably lower than the facility's Medicare benchmark of $32.40, indicating a markup of 2.3 times the federal rate. While the facility is a Critical Access Hospital with government-local ownership, patients should be aware that commercial insurance plans like Blue Cross Blue Shield, Wppa, and UnitedHealthcare have negotiated rates ranging from $34 to $76 depending on the specific plan. In scenarios where a patient has a high deductible or limited insurance coverage, paying the cash price of $76.00 upfront may result in lower out-of-pocket costs compared to insurance claims that could exceed this amount due to deductibles or co-pays.
To ensure you are receiving the most accurate and fair pricing, it is essential to request a full itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you are self-paying, ask the facility about "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full within a short window, bypassing the administrative costs associated with insurance claims. Additionally, if you receive a summary bill, insist on a detailed line-by-line statement to verify that all charges align with the negotiated or cash rates provided. Always confirm with the hospital whether your specific insurance plan is truly in-network for this service, as out-of-network care