Occupational therapy (self-care training)
Facility: Amberwell Atchison Association
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $92
- Cash Discount Price: $186
- vs. Medicare Baseline: 2.84x 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 284% of the Medicare baseline (a markup of 184%). 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 | $32 - $34 | 99% |
| Humana | $54 - $93 | 167% |
| Superior Select Mcr Adv - All Plans | $54 - $68 | 167% |
| Triwest - All Plans | $54 - $68 | 167% |
| UnitedHealthcare | $54 - $370 | 167% |
| Va Ccn - All Plans | $54 - $68 | 167% |
| Ambetter / Centene | $84 - $105 | 259% |
| Cigna | $91 - $113 | 281% |
| Aetna | $91 - $113 | 281% |
| Centrus Health Direct - All Plans | $124 - $154 | 383% |
| Oscar - All Plans | $124 - $154 | 383% |
| Multiplan - All Plans | $129 - $161 | 398% |
| Wppa Providrs Care - All Plans | $148 - $185 | 457% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service (CPT 97535) at Amberwell Atchison Association in Atchison, KS, the cash price is $186.00, which matches the facility's median negotiated rate of $186.00. This cash price is significantly higher than the state average for this procedure, which is $74.00. While commercial insurance plans like Blue Cross Blue Shield and Humana negotiate rates ranging from $32 to $113, these amounts often exceed the cash price, meaning patients with high-deductible plans might save money by paying the full cash price of $186.00 upfront rather than relying on insurance reimbursement.
Patients should be aware that commercial rates can sometimes be inflated due to administrative costs and contract structures, with some in-network negotiated rates reaching up to $185.00. To minimize costs, it is advisable to contact the hospital directly to inquire about "self-pay" or "prompt-pay" discounts, which can reduce the bill by 20% to 50% if paid in full before or shortly after the service. Additionally, if you are billed for services rendered by out-of-network providers at this facility, the No Surprises Act may protect you from balance billing for emergency care and non-emergency services at in-network hospitals, so you should request an audit if you receive unexpected charges.