Occupational therapy (self-care training)
Facility: Larkin Community Hospital Palm Springs Campus
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $70
- Cash Discount Price: $120
- vs. Medicare Baseline: 2.16x 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 216% of the Medicare baseline (a markup of 116%). 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 | $19 - $34 | 59% |
| Florida Community Care Mcaid-All Plans | $19 | 59% |
| Miami Childrens Hp Mcaid-All Plans | $19 | 59% |
| Sunshine Mcaid | $19 | 59% |
| Wellcare Mcaid | $19 | 59% |
| Medicare (plans) | $32 - $172 | 99% |
| Ambetter / Centene | $34 | 105% |
| Blue Cross Blue Shield | $34 - $258 | 105% |
| Opus Hospice Ip Only - All Plans | $34 | 105% |
| Clear Springs Health - All Plans | $35 | 108% |
| Unicare Simply Mcare Ppo - All Plans | $35 | 108% |
| Bright Health Commercial - All Other Plans | $40 | 123% |
| Cigna | $43 | 133% |
| Ccs - All Plans | $45 | 139% |
| Fdc - All Plans | $47 | 145% |
| Humana | $52 - $172 | 160% |
| Simply Healthcare Mcaid | $70 | 216% |
| United Mcaid | $70 | 216% |
| Wellcare Comm (Choice) - All Other Plans | $86 | 265% |
| UnitedHealthcare | $100 - $172 | 309% |
| Leon Med Center Mcr Adv - All Plans | $155 | 478% |
| Careplus Health - All Other Plans | $172 | 531% |
| Centurion Doc - All Plans | $172 | 531% |
| Doctors Healthcare - All Plans | $172 | 531% |
| Florida Health Solution/Hmo - All Plans | $172 | 531% |
| Preferred Care Partners Mcr - All Plans | $172 | 531% |
| Simply Healthcare Mcr - All Other Plans | $172 | 531% |
| Naphcare - All Plans | $198 | 611% |
| Oscar Health-All Plans | $344 | 1062% |