Occupational therapy (self-care training)
Facility: Northwest Health-La Porte
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $128
- Cash Discount Price: $81
- vs. Medicare Baseline: 3.95x 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 395% of the Medicare baseline (a markup of 295%). 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 |
|---|---|---|
| UnitedHealthcare | $27 - $186 | 83% |
| Tricare | $29 | 90% |
| Aetna | $30 - $204 | 93% |
| Blue Cross Blue Shield | $30 - $186 | 93% |
| Humana | $30 - $186 | 93% |
| Medicare (plans) | $30 | 93% |
| Node Champva | $31 | 96% |
| Node Devoted Health Mcr Adv | $31 | 96% |
| Node Hospice Non Par Agree | $31 | 96% |
| Node Va | $31 | 96% |
| One Call | $31 | 96% |
| Va Choice Program | $31 | 96% |
| Indiana Dept Of Correction | $32 | 99% |
| Managed Health Services | $32 - $186 | 99% |
| Node Pphp Mcr Adv | $33 | 102% |
| Lutheran | $41 - $67 | 127% |
| Us Department Of Labor | $48 | 148% |
| Self Pay | $50 - $133 | 154% |
| Encore | $56 - $222 | 173% |
| Prime Health In Work Comp | $56 | 173% |
| In Wc | $62 | 191% |
| Lutheran Network | $62 - $217 | 191% |
| Php | $62 - $102 | 191% |
| Lutheran Preferred Medpartners | $63 - $103 | 194% |
| Alpha Baking | $68 - $111 | 210% |
| Encore Kba Epo | $74 | 228% |
| Magnacare Ma | $76 | 235% |
| Php Freedom Network | $90 - $149 | 278% |
| Encore Kba Ppo | $93 | 287% |
| County Of Laporte | $105 - $173 | 324% |
| Cigna | $112 - $184 | 346% |
| Prime Health Services | $113 - $185 | 349% |
| Prime Health Services Auto | $113 - $185 | 349% |
| Ihn | $120 - $198 | 370% |
| Community Health Alliance | $131 - $215 | 404% |
| Sagamore Health Network | $132 - $217 | 407% |
| Chandler Group | $135 - $222 | 417% |
| Hfn Workers Compensation | $135 - $222 | 417% |
| Multiplan | $135 - $222 | 417% |
| Phcs | $135 - $222 | 417% |
| Caresource | $143 - $186 | 441% |
| Medicaid / KanCare | $186 | 574% |
| Mhs | $186 | 574% |