Occupational therapy (self-care training)
Facility: Johnson Memorial Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $99
- Cash Discount Price: $65
- vs. Medicare Baseline: 3.06x 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 306% of the Medicare baseline (a markup of 206%). 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 |
|---|---|---|
| Cca Senior Care Options | $34 | 105% |
| Medicare (plans) | $34 - $35 | 105% |
| Blue Cross Blue Shield | $34 - $131 | 105% |
| UnitedHealthcare | $34 - $369 | 105% |
| Aetna | $34 - $98 | 105% |
| Cigna | $35 - $115 | 108% |
| Connecticut Dept of Correction | $39 - $42 | 120% |
| Fallon Health | $45 | 139% |
| Claimdoc | $72 | 222% |
| Innovative Health Plan II | $72 | 222% |
| Diversified Administrators | $72 | 222% |
| Health New England | $76 - $82 | 235% |
| Centivo | $80 | 247% |
| Nippon Life Ins | $91 - $98 | 281% |
| Webtpa | $91 - $98 | 281% |
| Allied Benefit Systems | $91 - $98 | 281% |
| Hap | $91 - $98 | 281% |
| Luminare Health | $91 - $98 | 281% |
| 1199 National Benefit Fund | $91 - $98 | 281% |
| Gravie Admin Services | $91 - $98 | 281% |
| Meritain | $91 - $98 | 281% |
| Prime Health Services | $94 - $101 | 290% |
| PHCS | $97 - $105 | 299% |
| Multiplan | $97 - $105 | 299% |
| International Benefit Administrators | $97 - $105 | 299% |
| Trinity Health Share | $97 - $105 | 299% |
| Paramount HMO | $97 - $105 | 299% |
| Allied National Global Care | $97 - $105 | 299% |
| Manhattan Life | $97 - $105 | 299% |
| Mvp | $97 - $105 | 299% |
| Lifetime Benefit Solutions | $97 - $105 | 299% |
| Pan-American Life | $97 - $105 | 299% |
| Pai | $97 - $105 | 299% |
| Ghc Scw | $97 - $105 | 299% |
| Asrm - Reliance Standard Life Insurance | $97 - $105 | 299% |
| Medi Share | $97 - $105 | 299% |
| Family Life Insurance Company | $97 - $105 | 299% |
| Christian Care Ministry | $97 - $105 | 299% |
| Dean Health | $97 - $105 | 299% |
| Health Smart | $99 - $107 | 306% |
| Magnacare | $107 - $115 | 330% |
| Health Partners | $107 - $115 | 330% |
| Allegiance | $107 - $115 | 330% |
| United Behavioral Health Eap | $117 - $126 | 361% |
| Wc Domestic | $131 | 404% |
| Blue Shield - Ny Highmark Northeastern | $131 | 404% |
| Unicare | $131 | 404% |
| Blue Care Network | $131 | 404% |
| Blue Distinction Transplant | $131 | 404% |
| Kaiser Domestic | $131 | 404% |
| Pre-Employment | $131 | 404% |
| Bcn Domestic | $131 | 404% |
| Health Choices | $131 | 404% |
| Blue Shield - Ca | $131 | 404% |
| Blue Benefit Administrators of Massachusetts | $131 | 404% |
| Wellpoint | $131 | 404% |
| Blue Shield - Ny Highmark Western | $131 | 404% |
| Blue Shield - Id (Regence) | $131 | 404% |
| Blue Shield - Wa (Regence) | $131 | 404% |
| Blue Shield - PA (Highmark) | $131 | 404% |
| Connecticare | $242 - $314 | 747% |
| Harvard Pilgrim Healthcare | $369 | 1139% |
| Geha | $369 | 1139% |