Occupational therapy (self-care training)
Facility: Nemours Children's Hospital, Delaware
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $112
- Cash Discount Price: $197
- vs. Medicare Baseline: 3.46x 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 346% of the Medicare baseline (a markup of 246%). 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 |
|---|---|---|
| Tricare | $32 | 99% |
| Us Family Health Plan | $36 | 111% |
| Keystone First Hlth Plan | $39 - $87 | 120% |
| Celtic Transplant | $55 - $197 | 170% |
| Celtic Transplant For De First Health | $69 | 213% |
| UnitedHealthcare | $72 - $123 | 222% |
| Wellpoint Maryland | $73 | 225% |
| Kidz Partners | $75 | 231% |
| Health Partners | $76 | 235% |
| Upmc | $78 | 241% |
| Fidelis | $79 | 244% |
| Aetna | $84 - $114 | 259% |
| Blue Cross Blue Shield | $87 - $174 | 269% |
| Priority Partners John Hopkins | $97 | 299% |
| Six Degrees Health Transplant | $98 | 302% |
| Cigna | $108 - $124 | 333% |
| Great West-One Health Plan | $108 - $124 | 333% |
| Ambetter / Centene | $112 | 346% |
| Amerihealth Caritas Delaware | $112 | 346% |
| Geisinger Health Plan | $118 | 364% |
| Integra Administrative Group | $118 | 364% |
| National Transplant Network (Ntn) | $128 | 395% |
| Six Degrees Health | $128 | 395% |
| Star Healthcare Network | $128 | 395% |
| Life Trac Solid Organ And Bmt Transplant | $138 | 426% |
| First Health Network | $187 | 577% |
| Insurance Administrators Of America | $187 | 577% |
| Interlink Transplant Network | $187 | 577% |
| Multiplan | $187 | 577% |
| Preferred Healthcare | $187 | 577% |
| Private Healthcare Systems | $187 | 577% |
| Three Rivers Provider Network | $187 | 577% |