Occupational therapy (self-care training)
Facility: Medstar Harbor Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $156
- Cash Discount Price: $153
- vs. Medicare Baseline: 4.81x 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 481% of the Medicare baseline (a markup of 381%). 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 | $119 - $193 | 367% |
| Amerigroup | $119 - $193 | 367% |
| Amerihealth Caritas District Of Columbia | $119 - $193 | 367% |
| Carefirst Advantage Inc | $119 - $193 | 367% |
| Carefirst Blue Choice Inc | $119 - $193 | 367% |
| Cigna | $119 - $193 | 367% |
| First Health | $119 - $193 | 367% |
| Hscsn | $119 - $193 | 367% |
| Humana | $119 - $193 | 367% |
| Kaiser Permanente | $119 - $193 | 367% |
| Magellan Behavioral Health Inc | $119 - $193 | 367% |
| Mamsi | $119 - $193 | 367% |
| Medstar Family Choice | $119 - $193 | 367% |
| Medstar Family Choice Inc | $119 - $193 | 367% |
| Ncppo Healthlink Ppo | $119 - $193 | 367% |
| Pfc | $119 - $193 | 367% |
| Private Healthcare Systems (Phcs) | $119 - $193 | 367% |
| Tricare | $119 - $193 | 367% |
| United Behavioral Health Inc | $119 - $193 | 367% |
| UnitedHealthcare | $119 - $193 | 367% |
Consumer Guidance & Cost Commentary
For patients paying cash directly, the most important factor to know is that the cash median rate for this service is $153. While commercial insurance plans typically negotiate higher rates, cash-pay options can sometimes be more cost-effective for individuals with high-deductible plans, as the negotiated rate of $193 is significantly higher than the self-pay price. Patients should proactively ask the hospital for "self-pay" or "prompt-pay" discounts before scheduling, as these upfront incentives can bypass administrative fees and reduce the final bill.
The context of this pricing reveals that the cash rate of $153 is lower than the facility's gross charge of $156, yet it remains substantially higher than the Medicare benchmark of $32.40, which serves as a federal cost baseline for this procedure. Although the facility is a Voluntary non-profit hospital with a 4-star rating and serves 20 payers, the negotiated rates across all listed insurance plans, including UnitedHealthcare and Kaiser Permanente, consistently sit at $193. This demonstrates that for this specific code, the commercial negotiated rate is nearly six times the Medicare amount, highlighting the significant markup often found in commercial contracts compared to federal reimbursement standards.