Occupational therapy (self-care training)
Facility: Kosciusko Community Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $77
- Cash Discount Price: $40
- vs. Medicare Baseline: 2.38x 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 238% of the Medicare baseline (a markup of 138%). 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 | $19 - $46 | 59% |
| Self Pay | $19 - $85 | 59% |
| Theramatrix | $26 | 80% |
| UnitedHealthcare | $27 - $186 | 83% |
| Lutheran Preferred Network | $28 - $174 | 86% |
| Tricare | $29 | 90% |
| Aetna | $30 - $115 | 93% |
| Blue Cross Blue Shield | $30 - $186 | 93% |
| Humana | $30 - $186 | 93% |
| Medicare (plans) | $30 | 93% |
| Mhs | $30 - $186 | 93% |
| Department Of Veterans Affairs | $31 | 96% |
| Iu Health | $31 | 96% |
| Node Devoted Health Mcr Adv | $31 | 96% |
| Node Non Par Hospice Agree | $31 | 96% |
| Node Va | $31 | 96% |
| One Call Care Diagnostics Wc | $31 | 96% |
| Veterans Eval Services | $31 | 96% |
| In Dept Of Correction | $32 | 99% |
| Node Pphp Mcr Adv | $33 | 102% |
| Physicians Health Plan | $33 - $100 | 102% |
| Php Freedom Network | $34 - $84 | 105% |
| Encore | $36 - $87 | 111% |
| Trma Inc | $36 - $98 | 111% |
| Lutheran Advanced Network | $46 | 142% |
| Lutheran Preferred | $46 - $62 | 142% |
| Us Department Of Labor | $48 | 148% |
| Align In Work Comp | $50 | 154% |
| One Call Work Comp | $50 | 154% |
| Connecticut General Life Insurance Company | $52 - $128 | 160% |
| Cigna | $56 - $137 | 173% |
| Encore Work Comp In | $56 | 173% |
| Prime Health Services | $56 - $163 | 173% |
| Managed Health Services Exchange | $62 | 191% |
| Workers Comp | $62 | 191% |
| First Health Network | $67 - $163 | 207% |
| Advantage Health | $74 - $180 | 228% |
| Encore Kba Epo | $74 | 228% |
| Private Healthcare Systems | $77 - $187 | 238% |
| Sagamore | $78 - $204 | 241% |
| Encore Health Network | $83 - $202 | 256% |
| Encore Kba Ppo | $93 | 287% |
| Caresource | $143 - $186 | 441% |
| Managed Health Services | $186 | 574% |
| Medicaid / KanCare | $186 | 574% |