Occupational therapy (self-care training)
Facility: Wooster Community Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $90
- Cash Discount Price: $112
- vs. Medicare Baseline: 2.78x 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 278% of the Medicare baseline (a markup of 178%). 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 |
|---|---|---|
| Buckeye Mcaid-All Other Plans | $27 | 83% |
| Caresource Mcaid | $27 | 83% |
| UnitedHealthcare | $27 - $107 | 83% |
| Blue Cross Blue Shield | $28 - $103 | 86% |
| Molina Mcaid | $28 | 86% |
| Aetna | $29 - $112 | 90% |
| Amerihealth Mcaid-All Plans | $29 | 90% |
| Tricare | $30 | 93% |
| Buckeye Mcare | $31 | 96% |
| Caresource Mcr Adv | $31 | 96% |
| Humana | $31 - $106 | 96% |
| Med Mutual Of Oh Mcr | $31 | 96% |
| Molina Mcr | $31 | 96% |
| Summacare Mcr | $31 | 96% |
| The Health Plan Mcr Adv | $31 | 96% |
| Valor Hp Mcr-All Plans | $31 | 96% |
| Magnipower-All Plans | $40 | 123% |
| Caresource Exch - All Other Plans | $44 | 136% |
| Molina Marketplace - All Other Plans | $53 | 164% |
| Aultcare/Primecare Mcr Adv | $55 | 170% |
| Clarity Health - All Plans | $60 | 185% |
| Cerco-All Plans | $79 | 244% |
| Aultcare Wayne County | $84 | 259% |
| Aultcare/Primetime Exch | $84 | 259% |
| Rayco-All Plans | $84 | 259% |
| Christian Health Ministries-All Plans | $90 | 278% |
| Cigna | $90 | 278% |
| Health Ohio Network Employer | $90 | 278% |
| Wayne County-All Plans | $90 | 278% |
| Healthsmart Accel | $93 | 287% |
| Summacare Preferred Choice | $93 | 287% |
| Health Ohio Network Ppo-All Other Plans | $96 | 296% |
| Healthsmart Complete Ppo-All Other Plans | $96 | 296% |
| Ohio Health Choice Supp | $96 | 296% |
| Ohio Health Group Hlthy - All Other Plans | $96 | 296% |
| Med Mutual Of Oh Exchange | $97 | 299% |
| Med Mutual Of Oh Supermed | $97 | 299% |
| Med Mutual Of Oh Trad-All Other Plans | $97 | 299% |
| Health Plan Of Upper Ohio-All Plans | $99 | 306% |
| The Health Plan Comm - All Other Plans | $99 | 306% |
| Ohio Health Group Pref | $100 | 309% |
| Aultcare/Primetime-All Other Plans | $101 | 312% |
| Healthsmart Ppo | $102 | 315% |
| Summacare-All Other Plans | $105 | 324% |
| Ohio Health Choice-All Other Plans | $106 | 327% |
| Healthsmart Hpo | $107 | 330% |
| Osu-All Plans | $107 | 330% |
| Central Benefits-All Plans | $108 | 333% |
| First Health-All Plans | $108 | 333% |
| Flora-All Plans | $108 | 333% |
| Beech Street-All Plans | $109 | 336% |
| Phcs-All Plans | $109 | 336% |