Occupational therapy (self-care training)
Facility: Girard Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $29
- Cash Discount Price: $50
- vs. Medicare Baseline: 0.90x 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.
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 |
|---|---|---|
| Kansas Superior Select-All Plans | $29 | 90% |
| Blue Cross Blue Shield | $29 - $34 | 90% |
| Aetna | $29 - $147 | 90% |
| Humana | $29 | 90% |
| Ambetter / Centene | $29 | 90% |
| Medicare (plans) | $29 | 90% |
| UnitedHealthcare | $29 - $80 | 90% |
| Multiplan-All Plans | $78 | 241% |
| Uhhis-All Plans | $80 | 247% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at Girard Medical Center in Girard, KS, the cash median price is $50.00, which is significantly lower than the negotiated rates paid by insurance plans ranging from $29 to $147. While the facility's cash price is higher than the state average of $29.00, patients with high-deductible plans or those without insurance may find paying out-of-pocket cheaper than relying on insurance, which often results in higher allowed amounts due to administrative overhead and contract dynamics. It is important to note that while the facility is a Critical Access Hospital with government ownership, commercial payers like Aetna and UnitedHealthcare have negotiated rates that can exceed the cash price, so verifying your specific plan's allowed amount before scheduling is essential to avoid unexpected costs.
To ensure you are not overcharged, you should request an itemized billing audit before finalizing payment, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a balance bill for the difference between the provider's chargemaster and your insurance payment, remember that the No Surprises Act protects you from these surprise bills for emergency care and non-emergency services at in-network facilities. Additionally, since the facility offers a cash median of $50.00, you should ask about "prompt-pay" discounts or self-pay rates upfront; paying in full immediately can often bypass the costly insurance claims process and result in a lower final bill than what your insurance company has already negotiated or allowed.