Occupational therapy (self-care training)
Facility: Scott County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $115
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 3.55x 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 355% of the Medicare baseline (a markup of 255%). 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 |
|---|---|---|
| UnitedHealthcare | $19 - $122 | 59% |
| Blue Cross Blue Shield | $34 | 105% |
| Humana | $54 | 167% |
| Wppa | $77 - $1,200 | 238% |
| Aetna | $115 | 355% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Scott County Hospital, the negotiated rates paid by insurance plans range from $19 to $1,200, with a median negotiated amount of $115. This commercial rate is significantly higher than the Medicare benchmark of $32.40, which serves as the federal baseline for the true cost of care. While the facility is a Critical Access Hospital in Scott City, Kansas, the data does not provide specific cash or state/county average figures for this procedure. However, patients should be aware that cash payments can sometimes be more cost-effective than insurance claims, particularly for those with high-deductible plans where the insurer's allowed amount might exceed the cash price. It is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can offer immediate fee reductions for upfront payment.
When reviewing your bill, it is crucial to distinguish between the hospital's gross charges and the actual amount your insurance will pay. If you are out-of-network, you may face balance billing, where the provider bills you for the difference between the full chargemaster rate and your insurance's allowed amount. Fortunately, the No Surprises Act protects patients from such surprise bills for emergency care and non-emergency services at in-network facilities. If you receive a summary bill that obscures individual line items, you have the right to request a full itemized audit to identify errors, unbundled codes, or services not rendered. Since over 80% of hospital bills contain errors, obtaining a detailed, CPT-coded statement before negotiating is the most effective way to ensure you are only paying for the correct services at fair prices.