Occupational therapy (self-care training)
Facility: Shands Jacksonville
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $87
- Cash Discount Price: $99
- vs. Medicare Baseline: 2.69x 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 269% of the Medicare baseline (a markup of 169%). 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 | $20 - $148 | 62% |
| Carelon Health | $21 | 65% |
| Humana | $21 - $153 | 65% |
| Florida Community Care | $22 | 68% |
| Simply Healthcare | $22 | 68% |
| Amerihealth Caritas Florida | $23 | 71% |
| Community Care Plan | $23 | 71% |
| Molina | $23 - $53 | 71% |
| Ameri-Plus Preferred Care | $41 | 127% |
| Blue Cross Blue Shield | $41 - $98 | 127% |
| Capital Health Plan | $41 - $90 | 127% |
| Beacon Health Strategies | $43 | 133% |
| Florida Health Care Plan | $43 - $73 | 133% |
| UnitedHealthcare | $43 - $269 | 133% |
| Devoted Health Plan | $44 - $46 | 136% |
| Positive Healthcare Partners | $45 - $46 | 139% |
| Wellcare Of Florida | $48 | 148% |
| Florida Complete Care | $52 | 160% |
| Ambetter / Centene | $68 | 210% |
| Volusia Health Network | $75 | 231% |
| Northeast Florida State Hospital | $79 | 244% |
| Careplus Health Plan | $81 | 250% |
| North Florida Evaluation & Treatment Center | $84 | 259% |
| Wellpath | $90 | 278% |
| Centivo | $99 | 306% |
| Disney Cruise Line | $108 | 333% |
| Health First Health Plan | $117 - $126 | 361% |
| Mental Health Associates | $117 | 361% |
| Prime Health Services | $126 - $135 | 389% |
| Florida Health Alliance | $129 | 398% |
| Archbold Medical Center | $135 | 417% |
| Genex | $135 | 417% |
| Rockport Provider | $135 | 417% |
| Corvel Corp | $153 | 472% |
| First Health | $153 | 472% |
| Florida Hospital Healthcare System | $153 | 472% |
| Medsave Usa Tpa | $153 | 472% |
| Fringe Benefits Coordinators | $162 - $170 | 500% |
| Multiplan | $162 | 500% |
| Novanet | $162 | 500% |
| Avmed | $163 - $173 | 503% |
| Cigna | $176 | 543% |