Occupational therapy (self-care training)
Facility: St Francis Hospital & Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $163
- Cash Discount Price: $166
- vs. Medicare Baseline: 5.03x 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 503% of the Medicare baseline (a markup of 403%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $30 - $37 | 93% |
| Aetna | $34 - $223 | 105% |
| Cca Senior Care Options | $34 | 105% |
| Medicare (plans) | $34 - $35 | 105% |
| UnitedHealthcare | $34 - $433 | 105% |
| Cigna | $35 - $242 | 108% |
| Bcn Domestic | $37 | 114% |
| Blue Benefit Administrators of Massachusetts | $37 | 114% |
| Blue Care Network | $37 | 114% |
| Blue Distinction Transplant | $37 | 114% |
| Blue Shield - Ca | $37 | 114% |
| Blue Shield - Id (Regence) | $37 | 114% |
| Blue Shield - Ny Highmark Northeastern | $37 | 114% |
| Blue Shield - Ny Highmark Western | $37 | 114% |
| Blue Shield - PA (Highmark) | $37 | 114% |
| Blue Shield - Wa (Regence) | $37 | 114% |
| Health Choices | $37 | 114% |
| Kaiser Domestic | $37 | 114% |
| Pre-Employment | $37 | 114% |
| Unicare | $37 | 114% |
| Wc Domestic | $37 | 114% |
| Wellpoint | $37 | 114% |
| Fallon Health | $45 | 139% |
| Centivo | $68 | 210% |
| Connecticut Dept of Correction | $68 | 210% |
| Innovative Health Plan II | $72 | 222% |
| Allegiance | $163 | 503% |
| Health Partners | $163 | 503% |
| Magnacare | $163 | 503% |
| Health New England | $167 | 515% |
| Connecticare | $204 - $249 | 630% |
| Allied National Global Care | $205 | 633% |
| Asrm - Reliance Standard Life Insurance | $205 | 633% |
| Christian Care Ministry | $205 | 633% |
| Dean Health | $205 | 633% |
| Family Life Insurance Company | $205 | 633% |
| Ghc Scw | $205 | 633% |
| International Benefit Administrators | $205 | 633% |
| Lifetime Benefit Solutions | $205 | 633% |
| Manhattan Life | $205 | 633% |
| Medi Share | $205 | 633% |
| Multiplan | $205 | 633% |
| Mvp | $205 | 633% |
| PHCS | $205 | 633% |
| Pai | $205 | 633% |
| Pan-American Life | $205 | 633% |
| Paramount HMO | $205 | 633% |
| Trinity Health Share | $205 | 633% |
| Prime Health Services | $211 | 651% |
| 1199 National Benefit Fund | $223 | 688% |
| Allied Benefit Systems | $223 | 688% |
| Gravie Admin Services | $223 | 688% |
| Hap | $223 | 688% |
| Luminare Health | $223 | 688% |
| Meritain | $223 | 688% |
| Nippon Life Ins | $223 | 688% |
| Webtpa | $223 | 688% |
| Health Smart | $257 | 793% |
| Geha | $433 | 1336% |
| Harvard Pilgrim Healthcare | $433 | 1336% |