Occupational therapy (self-care training)
Facility: North Shore Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $112
- Cash Discount Price: $401
- 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 |
|---|---|---|
| Aetna | $11 - $316 | 34% |
| Veterans Administration Mill Bill | $23 | 71% |
| Medicare (plans) | $29 - $439 | 90% |
| Humana | $31 - $75 | 96% |
| Devoted Health | $32 | 99% |
| Leon Health Inc | $32 | 99% |
| UnitedHealthcare | $32 - $364 | 99% |
| Employer Direct Healthcare | $33 - $41 | 102% |
| Hospice Other | $33 | 102% |
| Tricare | $33 | 102% |
| Veterans Administration Vaccn | $33 | 102% |
| Cigna | $34 - $220 | 105% |
| Healthsun Health Plans | $34 | 105% |
| Longevity Health Plan | $35 | 108% |
| Florida Pace Centers | $39 | 120% |
| Bright Health Management Commercial | $40 | 123% |
| Dimension Health Wc | $40 | 123% |
| Workers Compensation | $40 | 123% |
| Centurion Prison | $41 | 127% |
| Self Pay/Uninsured | $41 | 127% |
| Bc/Bs Myblue Hmo Hix | $47 - $58 | 145% |
| Bc/Bs Of Fl Health Options Hmo | $51 - $63 | 157% |
| Bc/Bs Of Fl Ppo | $51 - $63 | 157% |
| Bc/Bs Of Fl Simplyblue | $51 - $63 | 157% |
| Bc/Bs Of Fl Network Blue | $54 - $67 | 167% |
| Bc/Bs Of Fl Blue Select Exchange Non Par | $57 - $71 | 176% |
| Avmed Exchange | $58 | 179% |
| Ambetter / Centene | $61 | 188% |
| Molina Marketplace Program Exchange | $63 | 194% |
| Auto Insurance | $66 | 204% |
| Avmed Select Network | $67 | 207% |
| Amerihealth Caritas Next Exchange | $71 | 219% |
| Medicaid / KanCare | $89 - $439 | 275% |
| Oscar Health Plan Hix | $114 | 352% |
| Imagine Health | $161 | 497% |
| Avmed Broad Network | $171 | 528% |
| Bc/Bs Of Fl Phs | $184 - $228 | 568% |
| Magellan Behavioral Health | $213 - $264 | 657% |
| Dimensions International | $230 - $286 | 710% |
| First Health | $241 - $299 | 744% |
| Dimension Health Ppo | $266 - $329 | 821% |
| Beacon Health Strategies Commercial | $354 - $439 | 1093% |
| Commercial Non-Contracted | $354 - $439 | 1093% |
| Self Pay - Mcd Pending 100 Percent | $354 - $439 | 1093% |
| Single Case Agreement | $354 - $439 | 1093% |
| United Behavioral Health Psych | $354 - $439 | 1093% |