Occupational therapy (self-care training)
Facility: Bluffton Regional Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $101
- Cash Discount Price: $67
- vs. Medicare Baseline: 3.12x 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 312% of the Medicare baseline (a markup of 212%). 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 - $68 | 65% |
| Self Pay | $21 - $156 | 65% |
| Physicians Health Plan | $22 - $56 | 68% |
| Theramatrix | $26 | 80% |
| Lutheran Preferred Network | $27 - $226 | 83% |
| UnitedHealthcare | $27 - $186 | 83% |
| Cigna | $28 - $100 | 86% |
| Php | $28 - $54 | 86% |
| Php Freedom Network | $28 - $62 | 86% |
| Tricare | $29 | 90% |
| Aetna | $30 - $126 | 93% |
| Blue Cross Blue Shield | $30 - $186 | 93% |
| Medicare (plans) | $30 | 93% |
| Node Caresource Mcr Adv | $30 | 93% |
| Node Iu Health Mcr Adv | $30 | 93% |
| Node Mhs Mcr Adv | $30 | 93% |
| Department Of Veterans Affairs | $31 | 96% |
| Humana | $31 - $186 | 96% |
| Node Devoted Health Mcr Adv | $31 | 96% |
| Node Non Par Hospice Agree | $31 | 96% |
| Node Va | $31 | 96% |
| Northeast Hospice | $31 | 96% |
| Veterans Eval Services | $31 | 96% |
| County Jail Health Care | $32 | 99% |
| In Dept Of Correction | $32 | 99% |
| Node Pphp Mcr Adv | $33 | 102% |
| Php Management Systems | $34 - $110 | 105% |
| Lutheran Trma | $36 - $127 | 111% |
| Encore Ppo | $44 - $138 | 136% |
| Sagamore Sebt | $45 - $145 | 139% |
| Lutheran Advanced Network | $46 | 142% |
| Lutheran Three Rivers Preferred Plus 150 | $46 | 142% |
| Sagamore Health Newtork Inc | $48 - $152 | 148% |
| Us Department Of Labor | $48 | 148% |
| Lutheran Three Rivers Preferred Plus 175 | $54 | 167% |
| Consumer Life | $55 - $175 | 170% |
| Encore Work Comp In | $56 | 173% |
| Prime Health Services | $56 - $212 | 173% |
| Ahg Dana Employees | $58 - $184 | 179% |
| Align Networks | $62 - $198 | 191% |
| Lutheran Northwest Health Preferred | $62 | 191% |
| Managed Health Services Exchange | $62 | 191% |
| Workers Compensation | $62 | 191% |
| Medrisk In Work Comp | $65 | 201% |
| Private Healthcare Systems Inc | $67 - $212 | 207% |
| Multiplan | $71 - $226 | 219% |
| Encore Health Network | $73 - $255 | 225% |
| Advantage 360 | $74 - $235 | 228% |
| Encore Kba Epo | $74 | 228% |
| Community Health Alliance | $76 - $241 | 235% |
| First Health | $77 - $243 | 238% |
| Allied Benefit Systems | $80 - $255 | 247% |
| Cardinal Health Alliance | $80 - $255 | 247% |
| Ppom | $80 - $255 | 247% |
| Encore Kba Ppo | $93 | 287% |
| Caresource | $186 | 574% |
| Medicaid / KanCare | $186 | 574% |
| Mhs | $186 | 574% |
| Mhs In Hip | $186 | 574% |