Occupational therapy (self-care training)
Facility: Saint Alphonsus Medical Center - Nampa
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $91
- Cash Discount Price: $68
- vs. Medicare Baseline: 2.81x 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 281% of the Medicare baseline (a markup of 181%). 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 - $46 | 86% |
| Medicare (plans) | $30 - $32 | 93% |
| UnitedHealthcare | $30 - $94 | 93% |
| Aetna | $31 - $91 | 96% |
| Moda Health | $31 - $88 | 96% |
| American Health Advantage Of Idaho | $32 | 99% |
| Blue Cross Blue Shield | $34 - $96 | 105% |
| Blue Shield - Id (Regence) | $38 - $49 | 117% |
| Trillium Community Ohp | $46 | 142% |
| Asuris Northwest Health | $49 | 151% |
| Blue Shield - Wa (Regence) | $49 - $96 | 151% |
| Healthcare Management Admin | $49 | 151% |
| Prime Healthcare | $60 | 185% |
| 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 - $94 | 253% |
| First Health | $88 | 272% |
| Medi Share | $88 | 272% |
| Allied Benefit Systems | $91 | 281% |
| Ameriben | $91 | 281% |
| Asr Health Benefits | $91 | 281% |
| Boon Chapman | $91 | 281% |
| Christian Brother Services | $91 | 281% |
| Geha | $91 - $94 | 281% |
| Healthez | $91 | 281% |
| Luminare Health (Detroit) | $91 | 281% |
| Meritain | $91 | 281% |
| Rural Carrier Health Benefit Plan | $91 | 281% |
| Humana | $92 | 284% |
| Allied National Global Care | $94 | 290% |
| Asrm - Reliance Standard Life Insurance | $94 | 290% |
| Christian Care Ministry | $94 | 290% |
| Correctional Health Partners | $94 | 290% |
| Dean Health | $94 | 290% |
| Fallon Health | $94 | 290% |
| Family Life Insurance Company | $94 | 290% |
| First Choice Health | $94 | 290% |
| Ghc Scw | $94 | 290% |
| International Benefit Administrators | $94 | 290% |
| Lifetime Benefit Solutions | $94 | 290% |
| Manhattan Life | $94 | 290% |
| Pai | $94 | 290% |
| Pan-American Life | $94 | 290% |
| Paramount Hmo | $94 | 290% |
| Phcs | $94 | 290% |
| Providence | $94 - $300 | 290% |
| Trinity Health Share | $94 | 290% |
| 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% |