Occupational therapy (self-care training)
Facility: Merit Health Wesley
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $51
- Cash Discount Price: $163
- vs. Medicare Baseline: 1.57x 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.
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 |
|---|---|---|
| Tricare | $28 | 86% |
| First Choice | $29 - $512 | 90% |
| Humana | $29 | 90% |
| Magnolia | $29 | 90% |
| Medicare (plans) | $29 | 90% |
| Node Champva | $29 | 90% |
| Node Vantage Mcr Adv | $29 | 90% |
| UnitedHealthcare | $29 - $155 | 90% |
| Veterans Eval Services | $29 | 90% |
| Aetna | $30 - $267 | 93% |
| Magnolia Mcd Ms Chip | $30 | 93% |
| Medicaid / KanCare | $30 - $98 | 93% |
| Molina | $30 | 93% |
| Molina Chip | $30 | 93% |
| Node Devoted Health Mcr Adv | $30 | 93% |
| Node First Choice American Health Mcr Adv | $30 | 93% |
| Node Hospice Non Par Agree | $30 | 93% |
| Node Va | $30 | 93% |
| Node First Choice Wellcare Mcr Adv | $31 | 96% |
| Node Healthy Mississippi Mcr Adv | $33 | 102% |
| Advanced Health Systems | $35 | 108% |
| Blue Cross Blue Shield | $41 | 127% |
| Node Us Dept Of Labor | $46 | 142% |
| First Choice Molina | $51 | 157% |
| Magnolia Exchange | $52 | 160% |
| Ms Work Comp | $52 | 160% |
| Molina Exchange | $54 | 167% |
| First Choice Lgp | $65 | 201% |
| Vantage Health | $67 | 207% |
| Chs Group Health Plan | $128 | 395% |
| Self Pay | $134 - $192 | 414% |
| Cigna | $180 | 556% |
| Trimed Billing Solutions | $192 | 593% |
| Coventry First Health | $222 | 685% |
| Benefit Management Services | $416 | 1284% |
| Ms Dept Of Rehabilitation Services | $640 | 1975% |