Occupational therapy (self-care training)
Facility: Merit Health River Oaks
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $132
- Cash Discount Price: $135
- vs. Medicare Baseline: 4.07x 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 407% of the Medicare baseline (a markup of 307%). 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% |
| UnitedHealthcare | $29 - $176 | 90% |
| Veterans Eval Services | $29 | 90% |
| Aetna | $30 - $421 | 93% |
| Magnolia Mcd Chip | $30 | 93% |
| Medicaid / KanCare | $30 - $92 | 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% |
| First Choice Preferred | $45 | 139% |
| Node First Choice Occunet | $45 | 139% |
| Node Us Dept Of Labor | $46 | 142% |
| Node First Choice Seven Corners | $51 | 157% |
| Magnolia Exchange | $52 | 160% |
| Ms Work Comp | $52 | 160% |
| Prime Health Wc | $52 | 160% |
| Molina Exchange | $54 | 167% |
| First Choice Lgp | $65 | 201% |
| Vantage Health Commercial | $67 | 207% |
| Cigna | $120 | 370% |
| Self Pay | $132 | 407% |
| Trimed Billing Solutions | $180 | 556% |
| Ms State Hospital Of Whitfield Ms | $228 | 704% |
| First Choice Standard | $276 | 852% |
| First Choice Coventry | $313 | 966% |
| First Choice Mpcn Standard | $331 | 1022% |
| First Choice Ppo Plus | $331 | 1022% |
| Phcs | $361 | 1114% |
| Benefit Administration Services | $433 - $511 | 1336% |
| Benefit Management Systems | $433 - $511 | 1336% |
| Citizens State Bank Inc | $433 - $511 | 1336% |
| First Choice Stratose | $481 | 1485% |
| Prime Health Services | $481 | 1485% |
| American Health Group | $511 | 1577% |
| Beech Street | $511 | 1577% |
| Formost | $511 | 1577% |
| Usa Mco | $511 | 1577% |
| One Health Plan | $541 | 1670% |
| Ms Dept Of Rehabilitation Services | $601 | 1855% |