Occupational therapy (self-care training)
Facility: Fredonia Regional Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $80
- Cash Discount Price: $88
- vs. Medicare Baseline: 2.47x 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 247% of the Medicare baseline (a markup of 147%). 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 - $44 | 105% |
| UnitedHealthcare | $45 - $229 | 139% |
| Veterans Programs - All Plans | $45 | 139% |
| Aetna | $45 - $80 | 139% |
| Cigna | $80 | 247% |
| Reserve National-All Plans | $80 | 247% |
| Meritain-All Plans | $80 | 247% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, Occupational therapy (self-care training), the cash price at Fredonia Regional Hospital in Fredonia, KS is $88.00. This cash rate is significantly higher than the state average, which is $32.40, and also exceeds the Medicare benchmark of $32.40. While the facility is a Critical Access Hospital with government local ownership, patients should be aware that commercial insurance negotiated rates often exceed cash prices due to administrative overhead and contract structures. For instance, UnitedHealthcare plans in this area have negotiated rates ranging from $45 to $229, and Aetna rates range from $45 to $80. If you have a high-deductible plan, paying the $88.00 cash price upfront might be more cost-effective than relying on insurance, which could result in higher out-of-pocket costs if your deductible is not yet met.
To ensure you are receiving the best possible rate, it is crucial to request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. Do not accept a summary bill that only shows broad categories; instead, demand a detailed statement listing every CPT code and unit cost to identify any double-billing or unbundling. Additionally, ask the billing department about "self-pay" or "prompt-pay" discounts, which can reduce the total cost by 20% to 50% if you pay in full within a short window. Since balance billing protections under the No Surprises Act apply to emergency care and non-emergency services at in-network facilities, verify your