Occupational therapy (self-care training)
Facility: Baptist Beaumont Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $70
- Cash Discount Price: $48
- vs. Medicare Baseline: 2.16x 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 216% of the Medicare baseline (a markup of 116%). 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 |
|---|---|---|
| Aetna | $31 - $192 | 96% |
| Ameri-Plus Ppo-All Plans | $31 | 96% |
| Blue Cross Blue Shield | $31 - $76 | 96% |
| Cigna | $31 - $112 | 96% |
| Superior Health Plan Mcr Adv | $31 | 96% |
| Texan Plus-All Plans | $31 | 96% |
| Superior Health Plan Comm - All Other Plans | $35 | 108% |
| Texas Exchange Plans - All Plans | $35 | 108% |
| Americhoice - All Plans | $37 | 114% |
| Amerigroup - All Plans | $37 | 114% |
| Community Health Choice - All Plans | $37 | 114% |
| Medicaid / KanCare | $37 - $48 | 114% |
| Tchp Chips - All Plans | $37 | 114% |
| Beacon Health - All Plans | $43 | 133% |
| Correctcare - All Plans | $46 | 142% |
| Naphcare Inc - All Plans | $46 | 142% |
| Texas School Health Benefits - All Plans | $46 | 142% |
| Preferred Care Services - All Plans | $52 | 160% |
| Brookshire Brothers - All Plans | $69 | 213% |
| Imagine Healthcare (Smartcare) - All Plans | $93 | 287% |
| Signature Health - All Plans | $116 | 358% |
| Humana | $159 - $185 | 491% |
| Central Healthcare Services - All Plans | $185 | 571% |
| Mhhnp-All Plans | $185 | 571% |
| Pponext - All Plans | $240 | 741% |
| Multiplan - All Plans | $259 | 799% |
| Phcs - All Plans | $259 | 799% |
| First Health - All Plans | $278 | 858% |
| Healthsmart - All Plans | $278 | 858% |
| Managed Healthcare Inc - All Plans | $278 | 858% |
| Blue Bell - All Plans | $296 | 914% |