Occupational therapy (self-care training)
Facility: Madison County Health Care System
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $113
- Cash Discount Price: $101
- vs. Medicare Baseline: 3.49x 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 349% of the Medicare baseline (a markup of 249%). 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 | $54 - $82 | 167% |
| Medical Associates Hp - All Plans | $54 | 167% |
| Medigold-All Plans | $54 | 167% |
| Tricare | $54 | 167% |
| UnitedHealthcare | $54 - $113 | 167% |
| American Hp Mcr Adv-All Plans | $57 | 176% |
| Iowa Total Care Mcaid-All Plans | $59 | 182% |
| Molina Mcaid/Chip -All Plans | $61 | 188% |
| Amerigroup Mcaid-All Plans | $63 | 194% |
| Madison County Sheriff-All Plans | $63 | 194% |
| Oscar - All Plans | $81 | 250% |
| Corvel Wc-All Plans | $113 | 349% |
| Choicecare-All Plans | $120 | 370% |
| First Choice-All Plans | $120 | 370% |
| First Health-All Plans | $120 | 370% |
| Integrated Hp-All Plans | $120 | 370% |
| Mutual Of Omaha-All Plans | $120 | 370% |
| Plaines Health-All Plans | $120 | 370% |
| Preferred Hlth Ntwork-All Plans | $120 | 370% |
| Principal Healthcare-All Plans | $120 | 370% |
| Usa Managed Care-All Plans | $120 | 370% |
| Blue Cross Blue Shield | $121 - $133 | 373% |
| Medimore Employee Hp - All Plans | $123 | 380% |
| Midlands Choice - All Plans | $123 | 380% |
| Benefit Admin Of America-All Plans | $126 | 389% |