Occupational therapy (self-care training)
Facility: Kingman Healthcare Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $136
- Cash Discount Price: Unavailable
- vs. Medicare Baseline: 4.20x 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 420% of the Medicare baseline (a markup of 320%). 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 |
|---|---|---|
| Humana | $136 | 420% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at Kingman Healthcare Center in Kingman, KS, the negotiated rate of $136.00 is significantly higher than the Medicare benchmark of $32.40, reflecting a markup of 4.2 times the federal baseline. While commercial insurance contracts often establish a ceiling to protect in-network members, these rates can exceed cash prices due to administrative overhead and contract dynamics. If you have a high-deductible plan or have already met your deductible, paying the cash price directly might be more cost-effective than relying on insurance, as the facility's cash rate is not listed but the negotiated rate suggests insurance coverage could result in higher out-of-pocket costs if the deductible is not met.
To minimize unexpected costs, we recommend asking the hospital about "self-pay" or "prompt-pay" discounts before scheduling, which can reduce the final bill by 20% to 50% for upfront payment. Since the facility is a Critical Access Hospital with a voluntary non-profit ownership structure, they may offer specific financial assistance programs not visible in standard billing data. Always request an itemized bill to verify that no services were double-billed or unbundled, as over 80% of hospital bills contain errors that can be corrected. Finally, ensure you are aware of your plan's deductible status before using insurance, as paying the full negotiated rate without meeting your deductible threshold can lead to significantly higher expenses than paying cash directly.