Hospitals report these codes with terse, inconsistent chargemaster text. This plain-English title was written by an AI model from that text and has not been reviewed by a person, so it can be wrong. The prices on this page come straight from hospital filings and do not depend on it.
Original text from hospital filings
HC OT EVALUATION 15 MIN LOW COMPLEX
Princeton, IN
See all hospitals reporting CPT 97165 →Price type
Deaconess Health System Gibson General Hospital’s median price of $135 is 13% below the median hospital's median price ($155), higher than 42% of the 2,514 hospitals reporting CPT 97165. The highlighted bar is where this hospital falls; shaded is the middle 50% of hospitals.
Negotiated rates from the hospital’s own file: 9 payers, 33 plan rates. A facility fee, a professional fee, a per diem and a case rate are different bills, so each is listed on its own. Open a payer to see it across hospitals.
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| # | ||||
|---|---|---|---|---|
| 1 | Aetna medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $42.25 | $42.25 | $42.25 – $42.25 |
| 2 | UnitedHealthcare commercial professional · percent of total billed charges · bothfrom % of charges | $50.00 | $50.00 | $50.00 – $50.00 |
| 3 | Ambetter commercial facility · percent of total billed charges · outpatientfrom % of charges | $54.08 | $54.08 | $54.08 – $54.08 |
| 4 | Anthem commercial facility · percent of total billed charges · outpatientfrom % of charges | $54.08 | $54.08 | $54.08 – $54.08 |
| 5 | Anthem medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $54.08 | $54.08 | $54.08 – $54.08 |
| 6 | Bcbs Il medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $54.08 | $54.08 | $54.08 – $54.08 |
| 7 | Caresource commercial facility · percent of total billed charges · outpatientfrom % of charges | $54.08 | $54.08 | $54.08 – $54.08 |
| 8 | UnitedHealthcare medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $54.08 | $54.08 | $54.08 – $54.08 |
| 9 | WellCare dual medicare/medicaid facility · percent of total billed charges · outpatientfrom % of charges | $54.08 | $54.08 | $54.08 – $54.08 |
| 10 | WellCare medicare advantage facility · percent of total billed charges · outpatientfrom % of charges | $54.08 | $54.08 | $54.08 – $54.08 |
| 11 | Anthem medicare advantage facility · other · inpatient | $62.53 | $62.53 | $62.53 – $62.53 |
| 12 | Anthem medicare advantage professional · other · both | $62.53 | $62.53 | $62.53 – $62.53 |
| 13 | UnitedHealthcare medicare advantage facility · other · inpatient | $62.53 | $62.53 | $62.53 – $62.53 |
| 14 | UnitedHealthcare medicare advantage professional · other · both | $62.53 | $62.53 | $62.53 – $62.53 |
| 15 | Caresource commercial professional · percent of total billed charges · bothfrom % of charges | $87.50 | $87.50 | $87.50 – $87.50 |
| 16 | Caresource managed medicaid facility · other · inpatient | $91.37 | $91.37 | $91.37 – $91.37 |
| 17 | Caresource managed medicaid facility · other · outpatient | $91.37 | $91.37 | $91.37 – $91.37 |
| 18 | Caresource managed medicaid professional · other · both | $91.37 | $91.37 | $91.37 – $91.37 |
| 19 | UnitedHealthcare commercial facility · percent of total billed charges · inpatientfrom % of charges | $118.30 | $118.30 | $118.30 – $118.30 |
| 20 | UnitedHealthcare commercial facility · percent of total billed charges · outpatientfrom % of charges | $118.30 | $118.30 | $118.30 – $118.30 |
| 21 | Anthem commercial facility · other · inpatient | $118.54 | $118.54 | $96.07 – $141.00 |
| 22 | Anthem commercial professional · other · both | $118.54 | $118.54 | $96.07 – $141.00 |
| 23 | Anthem commercial facility · per diem · outpatient | $129.50 | $129.50 | $113.00 – $146.00 |
| 24 | Aetna commercial facility · fee schedule · outpatient | $131.99 | $131.99 | $131.99 – $131.99 |
| 25 | Aetna commercial facility · percent of total billed charges · inpatientfrom % of charges | $131.99 | $131.99 | $131.99 – $131.99 |
Last updated: Feb 11, 2026
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