Occupational therapy (self-care training)
Facility: Dupont Hospital LLC
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $67
- Cash Discount Price: $48
- vs. Medicare Baseline: 2.07x 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 207% of the Medicare baseline (a markup of 107%). 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 |
|---|---|---|
| Physicians Health Plan | $22 - $80 | 68% |
| Amish Aid | $24 - $56 | 74% |
| Self Pay | $24 - $93 | 74% |
| Lutheran Preferred | $26 - $124 | 80% |
| UnitedHealthcare | $27 - $186 | 83% |
| Cigna | $29 - $75 | 90% |
| Tricare | $29 | 90% |
| Aetna | $30 - $92 | 93% |
| Blue Cross Blue Shield | $30 - $186 | 93% |
| Humana | $30 - $186 | 93% |
| Medicare (plans) | $30 | 93% |
| Node Mhs Mcr Adv | $30 | 93% |
| Php Freedom Network | $30 - $66 | 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% |
| Veterans Eval Services | $31 | 96% |
| In Dept Of Correction | $32 | 99% |
| Node Pphp Mcr Adv | $33 | 102% |
| Encore Ppo | $44 - $103 | 136% |
| Lutheran Network | $44 - $103 | 136% |
| Lutheran Advanced Network | $46 | 142% |
| Lutheran Preferred Fixed 2 | $46 | 142% |
| Managed Health Services | $46 - $186 | 142% |
| Medical Mutual Of Oh | $47 - $109 | 145% |
| Sagamore | $48 - $95 | 148% |
| Us Department Of Labor | $48 | 148% |
| Align In Work Comp | $50 | 154% |
| Encore Work Comp In | $56 | 173% |
| Prime Health Services | $56 - $154 | 173% |
| In Work Comp | $62 | 191% |
| Frontpath | $71 - $165 | 219% |
| Encore Health Network | $73 - $185 | 225% |
| Advantage Health Solutions | $74 - $171 | 228% |
| Encore Kba Epo | $74 | 228% |
| Multiplan | $77 - $185 | 238% |
| Allied Benefit Systems | $80 - $185 | 247% |
| Encore Kba Ppo | $93 | 287% |
| Caresource | $186 | 574% |
| Medicaid / KanCare | $186 | 574% |