Occupational therapy (self-care training)
Facility: Good Samaritan Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $105
- Cash Discount Price: $577
- 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 |
|---|---|---|
| Aetna | $36 - $41 | 111% |
| Affinity Medical Group | $36 - $41 | 111% |
| Alignment Health Plan | $36 - $41 | 111% |
| Blue Cross Blue Shield | $36 - $41 | 111% |
| Central Health Plan | $36 - $41 | 111% |
| Clever Care Of Golden State | $36 - $41 | 111% |
| Easy Choice Health Plan | $36 - $41 | 111% |
| Humana | $36 - $495 | 111% |
| Managed Health Network | $36 - $41 | 111% |
| On Lok Senior Health | $36 - $41 | 111% |
| Palo Alto Medical | $36 - $54 | 111% |
| Santa Clara Family Health Plan | $36 - $134 | 111% |
| Scan Health Plan | $36 - $41 | 111% |
| Triwest Healthcare Alliance | $36 - $41 | 111% |
| University Healthcare | $36 - $41 | 111% |
| Vitality Health Plan | $36 - $41 | 111% |
| Blue Shield | $37 - $146 | 114% |
| Care1St Health Plan | $37 - $42 | 114% |
| United | $37 - $180 | 114% |
| Health Net | $41 - $165 | 127% |
| Corvel Corporation | $42 - $48 | 130% |
| Affinity Medical Group Comm | $47 - $54 | 145% |
| Medcare Partners | $65 - $106 | 201% |
| Canopy | $66 - $74 | 204% |
| Bright Health | $87 - $142 | 269% |
| Nx Health Network | $259 - $424 | 799% |
| Sutter Select | $259 - $424 | 799% |
| Multiplan | $281 - $566 | 867% |
| First Health | $328 - $707 | 1012% |
| Cigna | $345 - $566 | 1065% |
| Healthsmart | $345 - $601 | 1065% |
| Intercontinental Corporation | $345 - $566 | 1065% |
| Pha Pacific Health Alliance | $345 - $566 | 1065% |
| Ppo Next | $345 - $566 | 1065% |