Occupational therapy (self-care training)
Facility: Memorial Hospital West
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $137
- Cash Discount Price: $148
- vs. Medicare Baseline: 4.23x 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 423% of the Medicare baseline (a markup of 323%). 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 | $13 - $427 | 40% |
| Avmed | $26 - $292 | 80% |
| Health Value Management | $29 - $106 | 90% |
| UnitedHealthcare | $33 - $174 | 102% |
| Sunshine | $35 - $128 | 108% |
| Emerging Therapy Solutions | $50 - $182 | 154% |
| Allianz | $54 - $198 | 167% |
| Axis | $54 - $198 | 167% |
| Desjardins Financial Security Life Assurance Company | $54 - $198 | 167% |
| Global Health Claims | $54 - $258 | 167% |
| Global Medical Management | $54 - $198 | 167% |
| Global Reach Health | $54 - $198 | 167% |
| National Healthcare Solutions | $54 - $198 | 167% |
| Plotkin | $54 - $198 | 167% |
| Quality Health Management | $54 - $198 | 167% |
| Quebec Inc | $54 - $198 | 167% |
| Star Healthcare Network | $54 - $198 | 167% |
| World Medical Care | $54 - $198 | 167% |
| Worldwide Managed Care Partners | $54 - $198 | 167% |
| Worldwide Medical Assurance | $54 - $198 | 167% |
| Dimension Health | $56 - $205 | 173% |
| Employers Choice Network | $66 - $243 | 204% |
| Gallagher Bassett | $66 - $243 | 204% |
| Health Sun | $70 | 216% |
| Cigna | $168 - $305 | 519% |
| Amerihealth Caritas | $190 | 586% |
| Community Care Plan | $205 | 633% |
| Molina | $210 | 648% |
| Employers Health Network | $280 | 864% |
| Broward County | $718 - $2,726 | 2216% |