Occupational therapy (self-care training)
Facility: Morris County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $50
- Cash Discount Price: $54
- vs. Medicare Baseline: 1.54x 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 |
|---|---|---|
| Blue Cross Blue Shield | $32 - $35 | 99% |
| Choice Care Mcr Adv-All Plans | $35 | 108% |
| Coventry Mcr | $35 | 108% |
| Va Ccn-All Plans | $35 | 108% |
| UnitedHealthcare | $35 - $90 | 108% |
| Cigna | $65 | 201% |
| Aetna | $81 | 250% |
| Multiplan-All Plans | $81 | 250% |
| Coventry Comm-All Other Plans | $81 | 250% |
| Providrs Care (Wppa)(Nexus)-All Plans | $135 | 417% |
Consumer Guidance & Cost Commentary
For the CPT code 97535, representing occupational therapy self-care training, the gross charge at Morris County Hospital in Council Grove, KS is $90.00. The facility's cash median price of $54.00 is significantly lower than the gross charge, offering a potential savings of $36.00 for patients paying out-of-pocket. While the facility is a Critical Access Hospital with government-local ownership, the negotiated rates vary widely among payers, ranging from $32.00 with Blue Cross Blue Shield to $135.00 with Providrs Care. It is important to note that while in-network insurance often caps costs, the negotiated rates can sometimes exceed the cash price; for instance, UnitedHealthcare's range extends up to $90.00, which matches the gross charge and leaves no room for patient savings compared to paying cash directly.
When evaluating the cost relative to federal standards, the Medicare amount for this service is $32.40. The facility's cash median of $54.00 represents a markup of approximately 67% over the Medicare rate, which falls within the typical range of fair pricing (120% to 150% of Medicare) and is notably lower than the commercial negotiated rates seen with some payers. Patients should be aware that balance billing is generally prohibited for emergency care at in-network facilities under the No Surprises Act, but it is crucial to verify the network status of all providers involved, including any ancillary services like labs or emergency physicians. To minimize costs, individuals should request a prompt-pay discount before scheduling, which can reduce the final bill by 20% to