Occupational therapy (self-care training)
Facility: Methodist Hospital Stone Oak
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $76
- Cash Discount Price: $411
- vs. Medicare Baseline: 2.35x 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 235% of the Medicare baseline (a markup of 135%). 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 |
|---|---|---|
| Superior Health | $19 - $51 | 59% |
| Wellmed | $26 - $30 | 80% |
| Triwest Va Pccc | $27 - $31 | 83% |
| Aetna | $28 - $512 | 86% |
| Amerigroup | $28 - $143 | 86% |
| Blue Cross Blue Shield | $28 - $302 | 86% |
| Devoted Health | $28 - $32 | 86% |
| Gonzaba Medical Group | $28 - $32 | 86% |
| Ilumed | $28 - $32 | 86% |
| Lighthouse Hospice | $28 - $32 | 86% |
| Triwest | $28 - $32 | 86% |
| United | $28 - $461 | 86% |
| UnitedHealthcare | $28 - $32 | 86% |
| American Health Plan Of Texas | $29 - $33 | 90% |
| Clover Insurance | $29 - $33 | 90% |
| Integranet | $29 - $32 | 90% |
| Texas Independent Health Plan | $29 - $33 | 90% |
| Wellcare | $29 - $32 | 90% |
| Triwest Health Alliance | $32 | 99% |
| Value Options | $32 | 99% |
| Focus Healthcare Management | $39 - $44 | 120% |
| Molina Healthcare | $44 - $50 | 136% |
| Community First Health Plans | $45 - $276 | 139% |
| Superior | $45 - $51 | 139% |
| Imperial Insurance | $72 - $194 | 222% |
| Oscar | $76 - $205 | 235% |
| Fidelis Securecare | $171 - $461 | 528% |
| National Choicecare | $189 - $205 | 583% |
| Texas Healthcare Foundation Heb | $189 - $205 | 583% |
| Tx Healthcare Foundation | $189 - $512 | 583% |
| Healthsmart Preferred Care | $208 - $563 | 642% |
| Independent Medical Systems | $208 - $563 | 642% |
| Physician Cooperative Of Texas | $208 - $226 | 642% |
| Haa Preferred Partners | $227 - $614 | 701% |
| San Antonio Employers Health Alliance | $227 - $614 | 701% |
| Coastal Comp Health Networks | $246 - $665 | 759% |
| National Healthcare Solutions | $246 - $665 | 759% |
| Tml Intergovernmental Ebp | $265 - $288 | 818% |
| Multiplan | $284 - $870 | 877% |
| Usa Managed Care | $284 - $308 | 877% |
| Blue Bell | $303 - $819 | 935% |
| Directcare America | $303 - $819 | 935% |
| Managed Healthcare | $322 - $870 | 994% |