Occupational therapy (self-care training)
Facility: Children's Hospital Colorado
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $122
- Cash Discount Price: $122
- vs. Medicare Baseline: 3.77x 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 377% of the Medicare baseline (a markup of 277%). 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 |
|---|---|---|
| Ccha Behavioral Health | $19 | 59% |
| Integrated Health Plan | $28 | 86% |
| Denver Health Medical Plan | $47 - $141 | 145% |
| Kaiser | $64 - $137 | 198% |
| Rocky Mountain Health Plan Behavioral Health | $75 | 231% |
| Blue Cross Blue Shield | $80 - $141 | 247% |
| Carelon Behavioral Health | $85 - $132 | 262% |
| Presbyterian Health Plan | $90 - $107 | 278% |
| Colorado Access | $92 | 284% |
| Colorado Access Behavioral Health | $92 | 284% |
| Molina Healthcare Of Nebraska | $103 | 318% |
| Molina Healthcare Of New Mexico | $103 | 318% |
| Peak Health Alliance/Ebms | $103 - $113 | 318% |
| Rocky Mountain Health Plan | $103 - $122 | 318% |
| Healthy Blue Of Nebraska | $109 | 336% |
| Humana | $115 - $132 | 355% |
| UnitedHealthcare | $117 - $126 | 361% |
| Evernorth Behavioral Health | $122 | 377% |
| Interlink National | $122 - $141 | 377% |
| Centivo | $130 | 401% |
| Select Health | $132 | 407% |
| Uchealth Plan Administrators | $132 | 407% |
| Cigna | $136 | 420% |
| Aetna | $137 - $150 | 423% |
| Department Of Corrections | $147 | 454% |
| Comppsych Behavioral Health | $160 | 494% |
| First Choice Health | $160 | 494% |
| Midlands Choice | $160 | 494% |
| National Preferred Provider Network | $160 | 494% |
| Multiplan | $162 | 500% |
| Cofinity | $169 | 522% |
| First Choice Of The Midwest | $169 | 522% |
| Usa Managed Care Organization | $169 | 522% |
| First Health Network | $173 | 534% |