Occupational therapy (self-care training)
Facility: Bob Wilson Memorial Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $87
- Cash Discount Price: $55
- vs. Medicare Baseline: 2.69x 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 269% of the Medicare baseline (a markup of 169%). 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 |
|---|---|---|
| Kansas Health | $31 - $57 | 96% |
| Humana | $31 - $57 | 96% |
| UnitedHealthcare | $31 - $148 | 96% |
| Medicare (plans) | $31 - $57 | 96% |
| Aetna | $31 - $142 | 96% |
| Blue Cross Blue Shield | $46 | 142% |
| Centura Employee Plan | $72 | 222% |
| Multiplan | $87 - $165 | 269% |
| Health Partners Of Kansas | $91 - $167 | 281% |
| Wppa | $92 - $169 | 284% |
Consumer Guidance & Cost Commentary
For the Occupational therapy (self-care training) service at Bob Wilson Memorial Hospital in Ulysses, KS, the cash median price is $55.00, which is significantly lower than the facility's negotiated rates. While the hospital's negotiated average is $87.00, commercial payers like UnitedHealthcare and Multiplan have negotiated rates ranging from $31 to $169, often exceeding the cash price. This pricing structure highlights a common billing dynamic where commercial insurance contracts can result in higher out-of-pocket costs for patients than paying cash directly. For individuals with high-deductible plans, paying the $55.00 cash median may be more cost-effective than relying on insurance, which could result in a negotiated bill well above the cash rate.
The facility's pricing also offers a clear benchmark against federal standards. The Medicare amount for this procedure is $32.40, and the facility's cash rate of $55.00 represents a markup of approximately 2.7 times the Medicare rate. While commercial negotiated rates typically average 200% to 300% of Medicare, the cash price here remains relatively close to the fair pricing range of 120% to 150% of Medicare, suggesting a more transparent cost structure for self-pay patients. To maximize savings, patients should request an itemized bill to verify that no unbundled codes or services not rendered are included, and they should explicitly ask about prompt-pay discounts before scheduling, as these upfront incentives can further reduce the final cost.