Occupational therapy (self-care training)
Facility: Texas Orthopedic Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $34
- Cash Discount Price: $246
- vs. Medicare Baseline: 1.05x 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.
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 |
|---|---|---|
| Superior Health Plan | $15 - $34 | 46% |
| Oscar | $28 - $48 | 86% |
| Wellmed | $28 - $32 | 86% |
| Amerigroup | $29 - $34 | 90% |
| Blue Cross Blue Shield | $29 - $113 | 90% |
| Cigna | $29 - $33 | 90% |
| Devoted Health | $29 - $33 | 90% |
| Humana | $29 - $331 | 90% |
| Integranet Amerigroup Ipa | $29 - $34 | 90% |
| Kelsey Seybold | $29 - $33 | 90% |
| Triwest Healthcare Alliance | $29 - $33 | 90% |
| United | $29 - $111 | 90% |
| Van Lang Ipa | $29 - $33 | 90% |
| Wellcare | $29 - $34 | 90% |
| American Health Plan | $30 - $34 | 93% |
| Procare Advantage | $30 - $34 | 93% |
| Provider Partners Health Plan Of Texas | $30 - $34 | 93% |
| Shared Health | $30 - $34 | 93% |
| Molina | $31 - $35 | 96% |
| Community Health Choice Mcd | $32 | 99% |
| Christus (Usfhp) | $33 | 102% |
| Universal Healthcare Group | $34 - $39 | 105% |
| Verda Health Plan | $37 - $42 | 114% |
| Texas Childrens Health Plans | $41 - $58 | 127% |
| Community Health Choice | $42 - $47 | 130% |
| Superior | $42 - $50 | 130% |
| Corvel Corporation | $57 - $64 | 176% |
| Texas Workforce Commission | $59 | 182% |
| Omni Healthcare | $60 - $68 | 185% |
| Molina Healthcare | $63 - $71 | 194% |
| Aetna | $87 - $157 | 269% |
| Healthsmart Preferred Care | $106 - $209 | 327% |
| Fidelis Securecare Of Tx | $111 | 343% |
| Coventry National First Health | $131 | 404% |
| Physicians Cooperative Of Texas | $135 | 417% |
| Rockport Workers Comp | $135 | 417% |
| Independent Medical System | $148 | 457% |
| National Healthcare Solutions | $148 | 457% |
| Southwest Medical | $148 | 457% |
| Coastal Comp | $160 | 494% |
| Multiplan | $184 - $209 | 568% |
| International Health Insurance | $197 | 608% |
| Physicians, Inc | $209 | 645% |
| Affiliated Ppo | $221 | 682% |
| Texas Athletic Network | $300 - $600 | 926% |