Occupational therapy (self-care training)
Facility: Holy Cross Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $86
- Cash Discount Price: $94
- vs. Medicare Baseline: 2.65x 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 265% of the Medicare baseline (a markup of 165%). 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 | $32 - $222 | 99% |
| Medicare (plans) | $32 - $35 | 99% |
| Preferred Care Partners | $32 | 99% |
| Ryan White Florida Mssrp | $32 | 99% |
| Trustbridge | $32 | 99% |
| UnitedHealthcare | $32 - $248 | 99% |
| Blue Cross Blue Shield | $33 - $324 | 102% |
| Careplus Health Plans | $33 | 102% |
| Catholic Hospice | $33 | 102% |
| Cigna | $33 - $166 | 102% |
| Vitas Healthcare Corp | $33 | 102% |
| Solis Health Plans | $35 | 108% |
| Avmed Health Plan | $36 - $231 | 111% |
| Wc Broward County | $38 | 117% |
| Wc Corvel | $38 | 117% |
| Wc Heritage Summit | $39 | 120% |
| Medicaid / KanCare | $43 - $144 | 133% |
| Oscar | $56 | 173% |
| First Health | $57 - $85 | 176% |
| Molina Marketplace | $58 | 179% |
| Ambetter / Centene | $59 | 182% |
| Curative | $61 | 188% |
| Centivo | $71 | 219% |
| Bridge Health | $72 | 222% |
| Community Care Plan | $78 - $144 | 241% |
| Memorial Integrated Health | $78 | 241% |
| Connecticare | $85 | 262% |
| Emblem Health | $85 | 262% |
| Allianz Global Assistance | $86 | 265% |
| Axa Assistance Us | $86 | 265% |
| Axis Services | $86 | 265% |
| Cmn Global | $86 | 265% |
| Desjardins Financial Security Life Assurance | $86 | 265% |
| Global Benefits Group | $86 | 265% |
| Global Health Claim Services | $86 | 265% |
| Global Medical Management | $86 | 265% |
| Guardian | $86 | 265% |
| Morgan White Administrators | $86 | 265% |
| National Healthcare Solutions | $86 | 265% |
| Olympus Managed Health Care | $86 | 265% |
| Penfield Care | $86 | 265% |
| Quality Health Management | $86 | 265% |
| Sanus Healthcare | $86 | 265% |
| Ww Concierge Healthcare Service | $86 | 265% |
| Sunmed International | $89 | 275% |
| Humana | $90 - $144 | 278% |
| International Generic | $94 | 290% |
| Phcs | $101 | 312% |
| Unicare | $101 | 312% |
| Multiplan | $127 | 392% |
| General Electric | $144 | 444% |
| Heartland Hospice | $144 | 444% |
| Hospice Vitas | $144 | 444% |
| Sunbelt International | $144 | 444% |
| Sunshine State Health Plan | $144 | 444% |
| Mvp | $166 | 512% |
| Upmc Health Plan | $166 | 512% |
| Allied Benefit Systems | $222 | 685% |
| Coventry | $222 | 685% |
| Meritain | $222 | 685% |
| Geha | $247 | 762% |
| Bcn Domestic | $309 | 954% |
| Blue Benefit Administrators Of Massachusetts | $309 | 954% |
| Blue Care Network | $309 | 954% |
| Blue Distinction Transplant | $309 | 954% |
| Blue Shield - Ca | $309 | 954% |
| Blue Shield - Id (Regence) | $309 | 954% |
| Blue Shield - Ny Highmark Northeastern | $309 | 954% |
| Blue Shield - Ny Highmark Western | $309 | 954% |
| Blue Shield - Pa (Highmark) | $309 | 954% |
| Blue Shield - Wa (Regence) | $309 | 954% |
| Health Choices | $309 | 954% |
| Kaiser Domestic | $309 | 954% |
| Pre-Employment | $309 | 954% |
| Wc Domestic | $309 | 954% |