Occupational therapy (self-care training)
Facility: Sweeny Community Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $84
- Cash Discount Price: $71
- vs. Medicare Baseline: 2.59x 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 259% of the Medicare baseline (a markup of 159%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $36 - $59 | 111% |
| Evercare Mcaid | $59 | 182% |
| UnitedHealthcare | $64 - $220 | 198% |
| Aetna | $69 - $95 | 213% |
| Amerigroup Mcr Adv - All Other Plans | $69 | 213% |
| Care Improvement Mcr - All Plans | $69 | 213% |
| Choicecare Mcr Adv - All Plans | $69 | 213% |
| Community Hlth Choice Him - All Other Plans | $69 | 213% |
| Coventry Mcr Adv | $69 | 213% |
| Molina Mcr Adv - All Other Plans | $69 | 213% |
| Superior Hp Mcr Adv-All Other Plans | $69 | 213% |
| Wellcare Mcare - All Plans | $69 | 213% |
| Community Hlth Choice Star | $84 | 259% |
| Molina Mcaid | $84 | 259% |
| Superior Hp Mcaid | $84 | 259% |
| Tx Chlidrens Hp Mcaid - All Plans | $84 | 259% |
| Tx True Choice Mcaid - All Plans | $84 | 259% |
| Beech Street - All Plans | $89 | 275% |
| Community Care Network - All Plans | $95 | 293% |
| Galaxy Health Network - All Plans | $107 | 330% |
| Multiplan - All Plans | $107 | 330% |
| Evercare Mcr Adv - All Other Plans | $115 | 355% |
| Amerigroup Mcaid | $118 | 364% |
| Cigna | $120 | 370% |