Occupational therapy (self-care training)
Facility: Crossgates River Oaks Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $65
- Cash Discount Price: $104
- vs. Medicare Baseline: 2.01x 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 201% of the Medicare baseline (a markup of 101%). 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 |
|---|---|---|
| Tricare | $28 | 86% |
| Humana | $29 | 90% |
| Medicare (plans) | $29 | 90% |
| Node Champva | $29 | 90% |
| Node First Choice Shared Health Of Ms Mcr Adv | $29 | 90% |
| Node Vantage Health Mcr Adv | $29 | 90% |
| Node Windsor Mcr Adv | $29 | 90% |
| UnitedHealthcare | $29 - $185 | 90% |
| Veterans Eval Services | $29 | 90% |
| Aetna | $30 - $290 | 93% |
| Medicaid / KanCare | $30 - $63 | 93% |
| Molina | $30 | 93% |
| Molina Chip | $30 | 93% |
| Node Devoted Health Mcr Adv | $30 | 93% |
| Node First Choice American Health Of Ms Mcr Adv | $30 | 93% |
| Node Hospice Non Par Agree | $30 | 93% |
| Node Magnolia Mcr Adv | $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% |
| First Choice Preferred | $45 | 139% |
| Node First Choice Occunet | $45 | 139% |
| Node Us Dept Of Labor | $46 | 142% |
| Ms Work Comp | $52 | 160% |
| Node Magnolia Exchange | $52 | 160% |
| Prime Health Wc | $52 | 160% |
| Molina Exchange | $54 | 167% |
| First Choice Lgp | $65 | 201% |
| Vantage Health Commercial | $67 | 207% |
| Cigna | $86 - $290 | 265% |
| Self Pay | $116 | 358% |
| Trimed Billing Solutions | $124 | 383% |
| Ms State Hospital Of Whitfield | $158 | 488% |
| First Choice Standard | $191 | 590% |
| First Choice Coventry | $216 | 667% |
| First Choice Mpcn Standard | $228 | 704% |
| First Choice Ppo Plus | $228 | 704% |
| Phcs | $249 | 769% |
| Benefit Management Systems | $299 - $353 | 923% |
| First Choice Stratose | $332 | 1025% |
| Prime Health Services | $332 | 1025% |
| American Health Group | $353 | 1090% |
| Beech Street | $353 | 1090% |
| Ibew | $353 | 1090% |
| One Health Plan | $374 | 1154% |
| Ms Dept Of Rehabilitation Services | $415 | 1281% |