Occupational therapy (self-care training)
Facility: Samaritan Hospital of Troy, New York
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $109
- Cash Discount Price: $70
- vs. Medicare Baseline: 3.36x 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 336% of the Medicare baseline (a markup of 236%). 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 |
|---|---|---|
| UnitedHealthcare | $23 - $383 | 71% |
| Blue Cross Blue Shield | $31 - $297 | 96% |
| Medicaid / KanCare | $31 - $108 | 96% |
| Medicare (plans) | $31 - $108 | 96% |
| Eddy Seniorcare Pace | $32 | 99% |
| Secure Horizons Ma Pffs | $32 | 99% |
| Aetna | $33 - $230 | 102% |
| Hudson Headwaters Pace | $34 | 105% |
| Nascentia Health Plus | $35 | 108% |
| Fidelis Care | $57 | 176% |
| Wellpath | $71 | 219% |
| First Health | $86 | 265% |
| Health Republic | $92 | 284% |
| Independent Health | $92 | 284% |
| Magnacare | $92 | 284% |
| Health New England | $97 | 299% |
| Multiplan | $97 | 299% |
| Phcs | $97 | 299% |
| Albany County Correctional Facility | $108 | 333% |
| Carelon Behavioral Health | $108 | 333% |
| Bcn Domestic | $123 | 380% |
| Blue Care Network | $123 | 380% |
| Unicare | $123 | 380% |
| Mvp | $158 - $170 | 488% |
| Blue Shield - Ny Highmark Northeastern | $167 - $297 | 515% |
| Capital District Physicians Health Plan | $203 | 627% |
| 1199 National Benefit Fund | $230 | 710% |
| Allied Benefit Systems | $230 | 710% |
| Asr Health Benefits | $230 | 710% |
| Christian Brother Services | $230 | 710% |
| Geha | $230 | 710% |
| Lucent Health | $230 | 710% |
| Luminare Health | $230 | 710% |
| Medical Mutual | $230 | 710% |
| Meritain | $230 | 710% |
| Trustmark Small Business Benefits | $230 | 710% |
| Allegiance | $269 | 830% |
| American Postal Workers Secondary | $269 | 830% |
| Cigna | $269 | 830% |
| Diversified Administrators | $269 | 830% |
| Health Partners | $269 | 830% |
| Priority Health | $269 | 830% |
| Tufts Health Plan | $269 | 830% |
| Webtpa | $269 | 830% |
| Blue Shield - Ca | $297 | 917% |
| Blue Shield - Id (Regence) | $297 | 917% |
| Blue Shield - Ny Highmark Western | $297 | 917% |
| Blue Shield - Pa (Highmark) | $297 | 917% |
| Blue Shield - Wa (Regence) | $297 | 917% |
| Emblem Health | $316 | 975% |
| Nova | $316 | 975% |
| Harvard Pilgrim Healthcare | $383 | 1182% |