Occupational therapy (self-care training)
Facility: Decatur County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $88
- Cash Discount Price: $82
- vs. Medicare Baseline: 2.72x 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 272% of the Medicare baseline (a markup of 172%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $33 | 102% |
| Champva -All Plans | $46 | 142% |
| Everystep Hospice-All Plans | $54 | 167% |
| Aetna | $56 - $81 | 173% |
| Tricare | $56 | 173% |
| UnitedHealthcare | $62 - $88 | 191% |
| Benefit Admin System-All Plans | $67 | 207% |
| Humana | $75 | 231% |
| Meritain Health-All Plans | $75 | 231% |
| Misc Commercial-All Plans | $75 | 231% |
| All Savers-All Plans | $77 | 238% |
| Allied Benefit System-All Plans | $77 | 238% |
| American Family Ins Grp-All Plans | $77 | 238% |
| Rural Carrier Benefit Plan-All Plans | $79 | 244% |
| Christian Healthcare -All Plans | $82 | 253% |
| Medica-All Other Plans | $82 | 253% |
| Golden Rule-All Plans | $88 | 272% |
| Ntca The Rural Broadband-All Plans | $88 | 272% |
| Cigna | $89 | 275% |
| Medical Mutual-All Plans | $91 | 281% |
| Farm Bureau Financial-All Other Plans | $93 | 287% |
| Farm Bureau Property And Ca | $93 | 287% |
| Medi Share-All Plans | $94 | 290% |
| Uhss-All Plans | $94 | 290% |
| Health Partners-All Plans | $95 | 293% |
| Lewermark-All Plans | $98 | 302% |
| Mail Handlers Benefit-All Plans | $101 | 312% |
| Midlands Choice-All Plans | $101 | 312% |
| Priority Health-All Plans | $103 | 318% |
| Iowa Total Care Mcaid-All Plans | $105 | 324% |
| Amerigroup Mcaid-All Plans | $108 | 333% |
| Wellmark Hmo | $121 | 373% |
| Wellmark Ppo - All Other Plans | $133 | 410% |