Occupational therapy (self-care training)
Facility: Memorial Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $105
- Cash Discount Price: $148
- vs. Medicare Baseline: 3.24x 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 324% of the Medicare baseline (a markup of 224%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $36 | 111% |
| Humana | $45 - $116 | 139% |
| Tricare | $45 - $116 | 139% |
| Medicare (plans) | $46 - $117 | 142% |
| Ambetter / Centene | $50 - $128 | 154% |
| Coventry - All Other Plans | $81 - $209 | 250% |
| Health Partners Of Kansas - All Plans | $86 - $221 | 265% |
| Preferred Healthcare-All Plans | $86 - $221 | 265% |
| Wppa/Providers Care-All Plans | $126 - $325 | 389% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service at Memorial Hospital in Abilene, KS, the cash price is $148.00, which matches the facility's median negotiated rate of $105.00 and the cash median of $148.00. While the facility is a Critical Access Hospital owned by a Government Hospital District, patients should be aware that insurance negotiated rates vary significantly by payer; for instance, Blue Cross Blue Shield pays $36, whereas Coventry plans may pay up to $209. Because the cash price ($148.00) is lower than the highest negotiated rates found in this dataset, paying out-of-pocket or utilizing a prompt-pay discount could result in immediate savings compared to relying on insurance reimbursement, which often involves higher administrative markups.
It is important to note that Medicare reimburses $32.40 for this code, serving as a baseline for fair pricing, while the facility's rating is 2. Patients should avoid accepting summary bills that obscure individual charges, as over 80% of hospital bills contain errors such as unbundled codes or services not rendered. If you receive a bill exceeding the cash price or a negotiated rate, request a formal itemized audit via certified mail to dispute any inaccuracies. Additionally, under the No Surprises Act, you are protected from balance billing for out-of-network services at in-network facilities, so any unexpected charges should be disputed with the insurer rather than paid immediately. Always verify your deductible status before scheduling, as paying the full cash price may be more cost-effective if your insurance has not yet met your deductible or if the negotiated rate exceeds the cash price.