Occupational therapy (self-care training)
Facility: St Joseph Health System, LLC
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $103
- Cash Discount Price: $72
- vs. Medicare Baseline: 3.18x 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 318% of the Medicare baseline (a markup of 218%). 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 |
|---|---|---|
| Amish Aid | $21 - $76 | 65% |
| Self Pay | $21 - $173 | 65% |
| Php | $22 - $126 | 68% |
| Lutheran Preferred | $25 - $189 | 77% |
| UnitedHealthcare | $27 - $186 | 83% |
| Php Freedom Network | $28 - $62 | 86% |
| Cigna | $29 - $315 | 90% |
| Tricare | $29 | 90% |
| Aetna | $30 - $214 | 93% |
| Blue Cross Blue Shield | $30 - $186 | 93% |
| Humana | $30 - $186 | 93% |
| Managed Health Services | $30 - $186 | 93% |
| Medicare (plans) | $30 | 93% |
| Department Of Veterans Affairs | $31 | 96% |
| Node Devoted Health Mcr Adv | $31 | 96% |
| Node Hospice Non Par Agree | $31 | 96% |
| Node Va | $31 | 96% |
| Veterans Eval Services | $31 | 96% |
| In Dept Of Correction | $32 | 99% |
| Node Pphp Mcr Adv | $33 | 102% |
| Lutheran Network | $40 - $173 | 123% |
| Three Rivers | $40 - $142 | 123% |
| Encore Ppo | $45 - $284 | 139% |
| Lutheran Advanced Network | $46 | 142% |
| Sagamore | $46 - $95 | 142% |
| Us Department Of Labor | $48 | 148% |
| Encore Work Comp In | $56 | 173% |
| Prime Health Services | $56 - $236 | 173% |
| Multiplan | $61 - $246 | 188% |
| Work Comp | $62 | 191% |
| First Health | $67 - $236 | 207% |
| Align Network | $71 - $252 | 219% |
| Frontpath Health Coalition | $71 - $252 | 219% |
| Advantage Health Solutions | $74 - $261 | 228% |
| Encore Kba Epo | $74 | 228% |
| Allied Benefit Systems | $80 - $284 | 247% |
| Medical Mutual Of Ohio | $89 - $315 | 275% |
| Parkview Healthplan Services | $89 - $315 | 275% |
| Value Options | $89 - $315 | 275% |
| Encore Kba Ppo | $93 | 287% |
| Caresource | $186 | 574% |
| Medicaid / KanCare | $186 | 574% |