Occupational therapy (self-care training)
Facility: Neosho Memorial Regional Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $71
- Cash Discount Price: $166
- vs. Medicare Baseline: 2.19x 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 219% of the Medicare baseline (a markup of 119%). 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 |
|---|---|---|
| Medicaid / KanCare | $19 | 59% |
| Blue Cross Blue Shield | $38 - $71 | 117% |
| Tricare | $68 | 210% |
| Medicare (plans) | $71 | 219% |
| Humana | $71 | 219% |
| Va_Ccn | $71 | 219% |
| Medadv_Allwell | $71 | 219% |
| Aetna | $71 | 219% |
| Medadv_Uhc | $71 | 219% |
| Ambetter / Centene | $112 | 346% |
| Wppa_Providrscare | $184 | 568% |
| United | $184 | 568% |
| Cigna | $210 | 648% |
| Coventry | $210 | 648% |
| Hpk | $210 | 648% |
Consumer Guidance & Cost Commentary
For CPT code 97535, Occupational therapy (self-care training), Neosho Memorial Regional Medical Center in Chanute, KS, lists a cash median of $166.00 and a negotiated median of $71.00 across 15 payers. This facility is a Critical Access Hospital with government-local ownership. While the cash price is notably higher than the negotiated rates, patients with high-deductible plans may find paying cash directly more cost-effective if their insurance negotiated rate exceeds the cash price. It is important to verify your specific plan's allowed amount before scheduling, as some in-network contracts can result in higher out-of-pocket costs than self-pay options.
To ensure you are not overcharged, always request an itemized bill that breaks down every CPT code and unit cost before agreeing to pay. Over 80% of hospital bills contain errors, such as unbundled charges or services not rendered, which can be identified through a formal audit dispute sent via certified mail. Additionally, if you receive a balance bill for out-of-network services at this facility, you may be protected under the No Surprises Act, which bans balance billing for emergency and non-emergency care at in-network hospitals. If you do receive such a bill, do not pay immediately; instead, dispute it with your insurer and request a No Surprises Act audit to avoid unexpected debt.