Occupational therapy (self-care training)
Facility: Shirley Ryan Abilitylab
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $142
- Cash Discount Price: $142
- vs. Medicare Baseline: 4.38x 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 438% of the Medicare baseline (a markup of 338%). 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 | $32 - $97 | 99% |
| Wellcare Meridian Fide | $32 | 99% |
| UnitedHealthcare | $32 - $135 | 99% |
| Tricare | $32 | 99% |
| Health Care Services Corporation | $32 - $113 | 99% |
| Humana | $32 | 99% |
| Advocate Health Partners | $33 - $236 | 102% |
| Blue Cross Blue Shield | $64 - $110 | 198% |
| Meridian Health Plan | $64 | 198% |
| County Care | $64 | 198% |
| Hfn | $83 - $212 | 256% |
| Coventry Workers Comp | $86 | 265% |
| Corvel Corporation | $86 | 265% |
| Multiplan | $86 | 265% |
| Personalcare Insurance of Il/Firsthealth Grp Corp/Coventryhealth and Life Insurance Co | $88 - $201 | 272% |
| Paradigm Health Corporation | $88 - $170 | 272% |
| State of Illinois | $88 - $126 | 272% |
| Uic Physician Group-Campuscare | $118 - $130 | 364% |
| Endeavor Health Sites 243/447 Northshore and Edwards | $130 | 401% |
| Uic Physician Group | $130 - $191 | 401% |
| Union Health Service | $132 | 407% |
| Cigna | $133 - $145 | 410% |
| University of Chicago Practice Plan | $142 - $153 | 438% |
| Affordable Health Care Concepts | $142 | 438% |
| Loyola University Physician Foundation | $153 | 472% |
| Health Care Services Corporation DBA Managed Care Network Preferred | $161 - $210 | 497% |
| Advocate and Advocate Health Partners | $165 | 509% |
| Resurrection Health Care Preferred | $177 - $189 | 546% |
| Gallagher Benefit Administrators | $177 | 546% |
| Health Care Services Corporation D/B/A HMO Illinois | $184 | 568% |
| Unicare Life and Health Insurance | $184 | 568% |
| Private Healthcare Systems | $189 | 583% |
| Health Payors Organization | $201 | 620% |
| Cofinity Aka Ppom | $201 | 620% |
| Healthnetwork | $208 - $224 | 642% |