Occupational therapy (self-care training)
Facility: Mercyone Newton Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $127
- Cash Discount Price: $94
- vs. Medicare Baseline: 3.92x 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 392% of the Medicare baseline (a markup of 292%). 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 |
|---|---|---|
| Iowa Total Care | $28 | 86% |
| Medicaid / KanCare | $29 | 90% |
| Aetna | $30 - $135 | 93% |
| Medicare (plans) | $30 - $32 | 93% |
| Blue Cross Blue Shield | $31 | 96% |
| UnitedHealthcare | $31 - $104 | 96% |
| Amish Hospital Aid | $41 | 127% |
| Centivo | $45 | 139% |
| Oscar | $47 | 145% |
| Ambetter / Centene | $52 | 160% |
| Claimdoc | $62 | 191% |
| Nova | $62 | 191% |
| Newton Correctional Facility | $94 | 290% |
| Geha | $104 | 321% |
| Health Choices | $109 | 336% |
| Medical Associates | $109 | 336% |
| Health Partners | $127 | 392% |
| Auxiant | $132 | 407% |
| Cigna | $132 | 407% |
| Health Alliance | $132 | 407% |
| Medica | $132 | 407% |
| Midlands | $132 | 407% |
| Midlands Choice | $132 | 407% |
| 1199 National Benefit Fund | $135 | 417% |
| Allied Benefit Systems | $135 | 417% |
| Asr Health Benefits | $135 | 417% |
| Christian Brother Services | $135 | 417% |
| Coventry | $135 | 417% |
| First Health | $135 | 417% |
| Lucent Health | $135 | 417% |
| Luminare Health | $135 | 417% |
| Medical Mutual | $135 | 417% |
| Meritain | $135 | 417% |
| Trustmark Small Business Benefits | $135 | 417% |
| Webtpa | $135 | 417% |
| Crime Victim Assistance | $144 | 444% |
| Iowa Dept Of Public Health | $144 | 444% |