Occupational therapy (self-care training)
Facility: Boulder Community Health
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $90
- Cash Discount Price: $139
- vs. Medicare Baseline: 2.78x 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 278% of the Medicare baseline (a markup of 178%). 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 |
|---|---|---|
| Humana | $23 - $33 | 71% |
| Colorado Community Health Alliance (Ccha) | $27 | 83% |
| Medicaid / KanCare | $29 | 90% |
| Rocky Mountain Health Maintenance Organization | $29 - $219 | 90% |
| Blue Cross Blue Shield | $32 - $165 | 99% |
| Colorado Access | $32 - $38 | 99% |
| Aetna | $33 - $241 | 102% |
| Devoted Health | $33 - $111 | 102% |
| Health Spring | $33 - $60 | 102% |
| Medicare (plans) | $33 - $105 | 102% |
| UnitedHealthcare | $33 - $418 | 102% |
| Clear Spring | $34 | 105% |
| Kaiser Ppo | $39 - $78 | 120% |
| Kaiser Public Option | $39 - $63 | 120% |
| Select Health Colorado Public Option | $40 - $105 | 123% |
| Select Health Value Network | $40 - $105 | 123% |
| Cigna | $42 - $246 | 130% |
| Beech Street Community Medical Associates | $51 | 157% |
| Multiplan | $54 - $194 | 167% |
| Phcs | $54 - $194 | 167% |
| Kaiser | $77 | 238% |
| Rocky Mountain Health Maintenance Organization Private Plan | $194 | 599% |
| Integrated Health Plans Bch | $208 | 642% |
| Casualty Management Network, Prime Health Services Behavioral Health | $235 | 725% |
| Mines And Associates | $235 | 725% |
| Three Rivers Provider Network | $235 | 725% |
| Zelis (Profee) | $235 | 725% |
| Casualty Management Network, Prime Health Services Community Medical Associates | $249 | 769% |
| National Preferred Provider Network | $249 | 769% |
| Rockport Healthcare Group Community Medical Associates | $249 | 769% |
| Usa | $249 | 769% |
| Rockport Healthcare Group Bch | $258 | 796% |
| Health Payors Organization | $263 | 812% |
| Health Management Network Bch Community Medical Associates | $266 | 821% |
| Health Management Network Community Medical Associates | $266 | 821% |
| National Provider Network | $269 | 830% |