Occupational therapy (self-care training)
Facility: Susan B Allen Memorial Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $554
- Cash Discount Price: $68
- vs. Medicare Baseline: 17.10x 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 1710% of the Medicare baseline (a markup of 1610%). 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 |
|---|---|---|
| UnitedHealthcare | $350 | 1080% |
| Providrs Care | $757 | 2336% |
Consumer Guidance & Cost Commentary
For this Occupational therapy (self-care training) service, the facility's cash price of $68.00 is significantly lower than the negotiated rates paid by UnitedHealthcare ($350) and Providrs Care ($757), as well as the Medicare benchmark of $32.40. While the cash rate is higher than the Medicare amount, it remains substantially below the commercial negotiated rates, which often include administrative overhead and contract premiums. Patients with high-deductible plans may find the cash price more affordable than their insurance allowed amount, especially if they have not yet met their deductible or if the insurer's negotiated rate exceeds the facility's self-pay pricing.
The facility, Susan B Allen Memorial Hospital in El Dorado, KS, offers a cash price that is notably lower than the state of Kansas average for this procedure, though specific county averages were not provided in the data. To secure the best possible rate, patients should explicitly request a "self-pay" or "prompt-pay" discount before scheduling, as hospitals often provide additional reductions for upfront payments that bypass the standard insurance billing cycle. It is important to verify the exact "self-pay" classification at registration to ensure the billing system does not automatically submit a claim to insurance, which could void any cash discount and result in higher out-of-pocket costs.