Occupational therapy (self-care training)
Facility: Hialeah Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $52
- Cash Discount Price: $736
- vs. Medicare Baseline: 1.60x 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.
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 | $22 - $530 | 68% |
| Veterans Administration Mill Bill | $23 | 71% |
| Medicare (plans) | $29 - $71 | 90% |
| Humana | $31 - $75 | 96% |
| Devoted Health | $32 | 99% |
| Leon Health Inc | $32 | 99% |
| UnitedHealthcare | $32 - $355 | 99% |
| Bristol Hospice- Miami Dade Llc | $33 | 102% |
| Catholic Hospice | $33 | 102% |
| Comprehensive Home Health Care Dba Opuscare Of South Florida | $33 | 102% |
| Employer Direct Healthcare | $33 - $41 | 102% |
| Hcr Manor Care Services Of Fl | $33 | 102% |
| Hospice Other | $33 | 102% |
| Odyssey Healthcare Of Marion County Dba Kindred Hospice | $33 | 102% |
| Seasons Hospice And Pallative Care Of Southern Florida Inc | $33 | 102% |
| Tricare | $33 | 102% |
| Veterans Administration Vaccn | $33 | 102% |
| Vitas Healthcare Hospice Corporation Of Fl | $33 | 102% |
| Vitas Hospice Unit Agreement | $33 | 102% |
| Cigna | $34 - $216 | 105% |
| Healthsun Health Plans | $34 | 105% |
| Longevity Health Plan | $34 | 105% |
| Florida Pace Centers | $39 | 120% |
| Bright Health Management Commercial | $40 | 123% |
| Dimension Health Wc | $40 | 123% |
| Workers Compensation | $40 | 123% |
| Self Pay/Uninsured | $41 | 127% |
| Naphcare Inc | $45 | 139% |
| 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% |
| Bc/Bs Myblue Hmo Hix | $98 | 302% |
| Bc/Bs Of Fl Health Options Hmo | $106 | 327% |
| Bc/Bs Of Fl Simplyblue | $106 | 327% |
| Bc/Bs Of Fl Miami Dade Blue Select | $112 | 346% |
| Bc/Bs Of Fl Network Blue | $112 | 346% |
| Bc/Bs Of Fl Ppo | $112 | 346% |
| Oscar Health Plan Hix | $114 | 352% |
| Bc/Bs Of Fl Blue Select Exchange Non Par | $119 | 367% |
| Imagine Health | $161 | 497% |
| Avmed Broad Network | $163 | 503% |
| Medicaid / KanCare | $184 | 568% |
| Bc/Bs Of Fl Phs | $381 | 1176% |
| Dimensions International | $478 | 1475% |
| First Health | $500 | 1543% |
| Dimension Health Ppo | $552 | 1704% |
| Commercial Non-Contracted | $736 | 2272% |
| Self Pay - Mcd Pending 100 Percent | $736 | 2272% |
| Single Case Agreement | $736 | 2272% |