Occupational therapy (self-care training)
Facility: Saint Alphonsus Regional Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $94
- Cash Discount Price: $68
- vs. Medicare Baseline: 2.90x 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 290% of the Medicare baseline (a markup of 190%). 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 |
|---|---|---|
| Ada County Jail Inmate Ins | $28 | 86% |
| Centurion Of Idaho | $28 | 86% |
| Id County Ada | $28 | 86% |
| Id County Canyon | $28 | 86% |
| Id County Cat Fund | $28 | 86% |
| Id County Payette | $28 | 86% |
| Idaho Dept Health And Wellfare | $28 | 86% |
| Medicaid / KanCare | $28 - $45 | 86% |
| Blue Cross Blue Shield | $30 - $96 | 93% |
| Medicare (plans) | $30 - $32 | 93% |
| UnitedHealthcare | $30 - $104 | 93% |
| Aetna | $31 - $95 | 96% |
| Moda Health | $31 - $94 | 96% |
| American Health Advantage Of Idaho | $32 | 99% |
| Blue Shield - Id (Regence) | $38 - $49 | 117% |
| Trillium Community Ohp | $45 | 139% |
| Asuris Northwest Health | $49 | 151% |
| Blue Shield - Wa (Regence) | $49 - $96 | 151% |
| Healthcare Management Admin | $49 | 151% |
| Selecthealth | $61 - $94 | 188% |
| Mountain Health Co-Op | $62 | 191% |
| Pacificsource Health Plans | $62 - $76 | 191% |
| Molina Marketplace | $73 | 225% |
| Columbia Health Network | $76 | 235% |
| Allegiance | $77 | 238% |
| Webtpa | $82 - $88 | 253% |
| Employee Benefit Management | $88 | 272% |
| First Choice Health | $88 | 272% |
| Providence | $88 - $300 | 272% |
| Humana | $92 - $104 | 284% |
| Allied National Global Care | $94 | 290% |
| Asrm - Reliance Standard Life Insurance | $94 | 290% |
| Christian Care Ministry | $94 | 290% |
| Dean Health | $94 | 290% |
| Fallon Health | $94 | 290% |
| Family Life Insurance Company | $94 | 290% |
| First Health | $94 | 290% |
| Geha | $94 - $95 | 290% |
| Ghc Scw | $94 | 290% |
| Healthnet | $94 | 290% |
| International Benefit Administrators | $94 | 290% |
| Lifetime Benefit Solutions | $94 | 290% |
| Manhattan Life | $94 | 290% |
| Medi Share | $94 | 290% |
| Pai | $94 | 290% |
| Pan-American Life | $94 | 290% |
| Paramount Hmo | $94 | 290% |
| Phcs | $94 | 290% |
| Trinity Health Share | $94 | 290% |
| Allied Benefit Systems | $95 | 293% |
| Ameriben | $95 | 293% |
| Asr Health Benefits | $95 | 293% |
| Boon Chapman | $95 | 293% |
| Christian Brother Services | $95 | 293% |
| Healthez | $95 | 293% |
| Luminare Health (Detroit) | $95 | 293% |
| Meritain | $95 | 293% |
| Rural Carrier Health Benefit Plan | $95 | 293% |
| Bcn Domestic | $96 | 296% |
| Blue Benefit Administrators Of Massachusetts | $96 | 296% |
| Blue Care Network | $96 | 296% |
| Blue Distinction Transplant | $96 | 296% |
| Blue Shield - Ca | $96 | 296% |
| Blue Shield - Ny Highmark Northeastern | $96 | 296% |
| Blue Shield - Ny Highmark Western | $96 | 296% |
| Blue Shield - Pa (Highmark) | $96 | 296% |
| Health Choices | $96 | 296% |
| Kaiser Domestic | $96 | 296% |
| Pre-Employment | $96 | 296% |
| Wc Domestic | $96 | 296% |
| Cigna | $300 | 926% |
| Priority Health | $300 | 926% |