Occupational therapy (self-care training)
Facility: Clay County Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $70
- Cash Discount Price: $75
- vs. Medicare Baseline: 2.16x 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 216% of the Medicare baseline (a markup of 116%). 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 |
|---|---|---|
| Wppa/Providrs Care- All Plans | $63 - $75 | 194% |
| Aetna | $63 - $75 | 194% |
| Health Partners - All Plans | $65 - $77 | 201% |
| Multiplan- All Plans | $65 - $77 | 201% |
| UnitedHealthcare | $65 - $77 | 201% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, Occupational therapy (self-care training), Clay County Medical Center in Clay Center, KS, lists a cash median price of $75.00 and a median negotiated rate of $70.00. This cash price is identical to the facility's gross charge, while the negotiated rate is slightly lower than the gross but higher than the cash option. The facility's cash price is 2.2 times the Medicare benchmark of $32.40, which serves as the objective baseline for evaluating pricing markups. Given that commercial negotiated rates often average 200% to 300% of Medicare, this facility's negotiated rate of $70.00 falls within the typical commercial range, though the cash price remains the lowest available option for patients without insurance.
Patients should be aware that paying cash upfront can sometimes be more cost-effective than using insurance, particularly if their plan has a high deductible or if the negotiated rate exceeds the cash price. While the facility is a Critical Access Hospital owned by the local government, the cash rate of $75.00 is significantly higher than the state average for this service, which is often lower than the facility's specific negotiated rates. To ensure you are receiving the best possible price, it is recommended to explicitly ask the billing department about "self-pay" or "prompt-pay" discounts before scheduling your visit. These discounts can reduce the final amount owed by bypassing the administrative costs associated with insurance claims processing.