Occupational therapy (self-care training)
Facility: Dukes Memorial Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $71
- Cash Discount Price: $111
- vs. Medicare Baseline: 2.19x 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 219% of the Medicare baseline (a markup of 119%). 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 |
|---|---|---|
| Department Of Veterans Affairs | $16 - $64 | 49% |
| Tricare | $16 - $64 | 49% |
| Aetna | $18 - $165 | 56% |
| Blue Cross Blue Shield | $18 - $186 | 56% |
| Humana | $18 - $186 | 56% |
| Iu Health Plan | $18 - $68 | 56% |
| Managed Health Services | $18 - $186 | 56% |
| Medicare (plans) | $18 - $68 | 56% |
| Node Devoted Health Mcr Adv | $18 - $69 | 56% |
| Node Va | $18 - $167 | 56% |
| UnitedHealthcare | $18 - $186 | 56% |
| In Dept Of Correction | $19 - $72 | 59% |
| Miami County Sheriffs Department | $19 - $72 | 59% |
| Node Pphp Mcr Adv | $19 - $73 | 59% |
| Lutheran Advanced Network | $27 - $104 | 83% |
| Lutheran Three Rivers Preferred Plus 150 | $27 - $104 | 83% |
| Node Lutheran Preferred Fixed 2 | $27 - $104 | 83% |
| Align Network | $28 - $111 | 86% |
| Lutheran Preferred | $28 - $277 | 86% |
| Lutheran Three Rivers Preferred Plus 175 | $31 - $121 | 96% |
| One Call Wc | $31 | 96% |
| Veterans Eval Services | $31 | 96% |
| Encore Work Comp In | $32 - $125 | 99% |
| Prime Health Services | $32 - $260 | 99% |
| Partners Direct Health Llc | $34 - $131 | 105% |
| Lutheran Northwest Health Preferred | $36 - $138 | 111% |
| Physicians Health Plan | $36 - $161 | 111% |
| Three Rivers Preferred Plus | $36 - $138 | 111% |
| Work Comp | $36 - $138 | 111% |
| Cigna | $38 - $346 | 117% |
| Three Rivers Preferred | $40 - $156 | 123% |
| Php Freedom | $41 - $160 | 127% |
| Encore Kba Epo | $43 - $166 | 133% |
| Amish Aid | $44 - $173 | 136% |
| Encore Ppo | $44 - $173 | 136% |
| Self Pay | $44 - $190 | 136% |
| Us Department Of Labor | $48 | 148% |
| Sagamore Health Network | $49 - $192 | 151% |
| Encore Kba Ppo | $53 - $208 | 164% |
| Consumer Life | $55 - $215 | 170% |
| First Health | $71 - $277 | 219% |
| Multiplan | $72 - $280 | 222% |
| Encore Health Network | $73 - $284 | 225% |
| Advantage Health Solutions | $74 - $287 | 228% |
| Encore | $80 - $311 | 247% |
| Caresource | $143 - $186 | 441% |
| Medicaid / KanCare | $186 | 574% |
| Mhs | $186 | 574% |