Occupational therapy (self-care training)
Facility: Mitchell County Hospital Health Systems
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $76
- Cash Discount Price: $73
- 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 |
|---|---|---|
| UnitedHealthcare | $31 - $84 | 96% |
| Blue Cross Blue Shield | $34 | 105% |
| Triwest Well Mark All Plans | $67 - $71 | 207% |
| Pref Hlth Care Sytms Comm - All Plans | $71 - $76 | 219% |
| Aetna | $71 - $76 | 219% |
| First Health-All Plans | $71 - $76 | 219% |
| Multiplan Ppo - All Plans | $75 - $80 | 231% |
| Phc Leased Ntwrk Access - All Plans | $75 - $80 | 231% |
| Auxiant-All Plans | $75 - $80 | 231% |
| Health Partners Ks-All Plans | $78 - $83 | 241% |
| Cigna | $78 - $83 | 241% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, Occupational therapy (self-care training), the facility in Beloit, KS, lists a gross charge of $82.00. While the facility's cash median rate is $73.00, commercial insurance plans typically pay higher negotiated amounts, ranging from $31 to $84 depending on the carrier. Notably, the lowest negotiated rate of $31 offered by UnitedHealthcare is significantly lower than the facility's cash price, which can be advantageous for patients with high-deductible plans who may not yet have met their out-of-pocket maximum. However, most other payers, including Blue Cross Blue Shield, Triwest Well Mark, and Aetna, negotiate rates between $67 and $84, which often exceed the cash-pay option. Patients should verify their specific plan's allowed amount before scheduling, as assuming that being in-network guarantees the lowest price can lead to higher costs if the insurer's negotiated rate is above the cash rate.
To minimize out-of-pocket expenses, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid upfront. Additionally, comparing the facility's pricing to the Medicare benchmark provides a clearer picture of value; the Medicare amount for this service is $32.40, which serves as a baseline for fair pricing. The facility's cash rate of $73.00 is approximately 2.3 times the Medicare amount, reflecting the standard administrative and service markups inherent in private billing. Since this facility is a Critical Access Hospital with government-local ownership, patients should also