Occupational therapy (self-care training)
Facility: Mt Sinai Hospital Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $72
- Cash Discount Price: $88
- vs. Medicare Baseline: 2.22x 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 222% of the Medicare baseline (a markup of 122%). 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 | $31 - $162 | 96% |
| Cigna | $31 - $171 | 96% |
| Tricare | $32 | 99% |
| Va Healthnet - All Plans | $32 | 99% |
| Advocate Physician Prtnrs Mcr | $33 | 102% |
| Cenpatico Illinicare Dual | $33 | 102% |
| Cenpatico Illinicare Mcr - All Other Plans | $33 | 102% |
| Humana | $33 - $508 | 102% |
| Lawndale Christian - All Plans | $33 | 102% |
| Meridian/Harmony D-Snp - All Plans | $33 | 102% |
| Nextlevel Hlth Icp Fhp Aca - All Plans | $33 | 102% |
| UnitedHealthcare | $33 - $638 | 102% |
| Harmony Behavioral Htlh - All Plans | $34 | 105% |
| Zing Mcr Adv - All Plans | $34 | 105% |
| Molina Mcr - All Other Plans | $35 | 108% |
| Oscar - All Plans | $35 - $178 | 108% |
| Advocate Physician Prtnrs - All Other Plans | $36 | 111% |
| Ambetter / Centene | $36 - $170 | 111% |
| Partners In Hlth - All Plans | $36 - $65 | 111% |
| Compsych Ip/Op Only - All Plans | $54 - $97 | 167% |
| Healthlink Hmo | $59 - $105 | 182% |
| Hfn Platinum | $59 - $105 | 182% |
| Healthlink Ppo - All Other Plans | $63 - $113 | 194% |
| Multiplan Primary Ntwrk/Phcs - All Other Plans | $63 - $113 | 194% |
| Hfn Epo | $73 - $129 | 225% |
| Multiplan Complementary Ntwrk | $73 - $129 | 225% |
| Hfn Ppo - All Other Plans | $80 - $142 | 247% |
| Aetna | $162 - $366 | 500% |
| Family Health Network Mcaid - All Plans | $162 | 500% |
| Molina Mcaid | $171 | 528% |