97537

Training for community or work reintegration, each 15 minutes

Medicare pricing data for 539 providers across 23 states

🤖AI Overview

Note: These costs reflect the Medicare physician/supplier component. Hospital facility fees are billed separately and can be 2-5x the physician fee.

💡 What You Should Know

Training for community or work reintegration, each 15 minutes (HCPCS code 97537) is a medical procedure billed to Medicare. The average Medicare-allowed cost is $25.26, but hospitals typically charge $52.45 — a 2.1x markup. Prices vary significantly by state and provider.

🏷️ Typical Out-of-Pocket Cost

$5.05

Medicare patients typically pay about 20% of the allowed amount as coinsurance. Based on the average allowed cost of $25.26, your out-of-pocket cost would be approximately $5.05. Actual costs depend on your specific plan, deductible, and whether you've met your annual out-of-pocket maximum.

Average Allowed Cost
$25.26
Average Hospital Charge
$52.45
Markup Ratio
2.1x

What Hospitals Charge vs. What Medicare Pays

Hospital Charge$52.45
Medicare Allowed$25.26
Medicare Payment$19.68

Hospitals charge 2.1x more than what Medicare allows for this procedure. Medicare actually pays $19.68 on average.

Cost by State

Medicare-allowed amounts vary significantly by state

StateAllowed CostHospital ChargeProvidersServicesvs. National
Alaska$35$109235+39.7%
New York$28$65433,286+12.5%
New Jersey$27$7120371+7.7%
California$26$5746513+1.9%
Minnesota$25$969210+0.6%
Maryland$25$50836+0.1%
Washington$25$4422209-1.5%
Virginia$25$4920337-1.7%
Illinois$25$5114114-2.4%
Utah$24$506140-3.4%
Florida$24$36458-4.0%
Arizona$24$447105-4.4%
Wisconsin$24$344168-4.5%
Texas$24$4314170-4.6%
Pennsylvania$24$4414182-5.9%
North Carolina$23$3812125-7.4%
Georgia$23$341092,782-8.2%
Alabama$23$339110-8.4%
Tennessee$23$3246648-8.5%
South Carolina$23$331258-8.9%
New Hampshire$23$558197-9.3%
Kentucky$22$8140717-11.2%
Colorado$22$33544-11.5%

⚠️ Important: These costs reflect the Medicare physician/supplier component. Hospital facility fees may be billed separately. Total out-of-pocket costs may be higher.

Related from TheDataProject.ai

💊 Need post-procedure medications? Check costs on OpenPrescriber