CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Chelsea Hospital
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $103
- Cash Discount Price: $101
- vs. Medicare Baseline: 3.18x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Chelsea Hospital is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $101. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.18x the Medicare baseline. Located in 775 S Main St, Chelsea, MI.
Cash / Self-Pay
$101
Average discount available for prompt cash payment at this facility.
Insurance Median
$103
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$32.4
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $32.4 (100%)
Cash / Self-Pay: $101 (312%)
Insurance Median: $103 (318%)
Cash: $101 (312% of Medicare)
Ins. Median: $103 (318% of 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 318% of the Medicare baseline (a markup of 218%). 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.
Input your details and click calculate to compare out-of-pocket costs.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Blue Cross Blue Shield | $18 - $58 | 56% |
| Medicaid / KanCare | $18 | 56% |
| Aetna | $32 - $85 | 99% |
| Align Senior Care | $32 | 99% |
| Angela Hospice | $32 | 99% |
| Arbor Hospice | $32 | 99% |
| Blue Care Network Advantage | $32 | 99% |
| Heartland Hospice | $32 | 99% |
| Medicare (plans) | $32 | 99% |
| UnitedHealthcare | $33 - $104 | 102% |
| Cca - Zing Health | $34 | 105% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $36 | 111% |
| Wc Accident Fund | $41 | 127% |
| Wc Advantage | $41 | 127% |
| Wc Aig | $41 | 127% |
| Wc Allied | $41 | 127% |
| Wc Amerisure | $41 | 127% |
| Wc Amtrust | $41 | 127% |
| Wc Asu Risk Mgt | $41 | 127% |
| Wc Berkley Admin | $41 | 127% |
| Wc Broadspire | $41 | 127% |
| Wc Bunch & Associates | $41 | 127% |
| Wc Ccmsi | $41 | 127% |
| Wc Emc Insurance Company | $41 | 127% |
| Wc Esis | $41 | 127% |
| Wc Fcci | $41 | 127% |
| Wc Federated | $41 | 127% |
| Wc Gallagher Bassett | $41 | 127% |
| Wc Genex Care For Ohio | $41 | 127% |
| Wc Guard Insurance Company | $41 | 127% |
| Wc Hartford | $41 | 127% |
| Wc Liberty Mutual | $41 | 127% |
| Wc Meijers | $41 | 127% |
| Wc Michigan | $41 | 127% |
| Wc Mitchell Frankenmuth | $41 | 127% |
| Wc Pma | $41 | 127% |
| Wc Sedgwick | $41 | 127% |
| Wc Sentry | $41 | 127% |
| Wc Travelers | $41 | 127% |
| Wc Tristar | $41 | 127% |
| Wc Walmart | $41 | 127% |
| Wc Zurich | $41 | 127% |
| Molina Marketplace | $42 | 130% |
| U Of M Health Plan | $49 | 151% |
| Health Cost Solutions | $50 | 154% |
| Vitalcore | $50 | 154% |
| Wellpath | $50 | 154% |
| Bcn Domestic | $58 | 179% |
| Blue Benefit Administrators Of Massachusetts | $58 | 179% |
| Blue Care Network | $58 | 179% |
| Blue Distinction Transplant | $58 | 179% |
| Blue Shield - Ca | $58 | 179% |
| Blue Shield - Id (Regence) | $58 | 179% |
| Blue Shield - Ny Highmark Northeastern | $58 | 179% |
| Blue Shield - Ny Highmark Western | $58 | 179% |
| Blue Shield - Pa (Highmark) | $58 | 179% |
| Blue Shield - Wa (Regence) | $58 | 179% |
| Health Choices | $58 - $103 | 179% |
| Kaiser Domestic | $58 | 179% |
| Priority Health | $68 - $76 | 210% |
| Employee Benefit Logistic | $72 | 222% |
| Geha | $85 - $104 | 262% |
| Meritain | $85 | 262% |
| Asr Health Benefits | $87 | 269% |
| Caresource | $87 | 269% |
| Hap | $87 - $120 | 269% |
| Varipro | $87 | 269% |
| Access Health | $103 | 318% |
| Acclaim | $103 | 318% |
| Administrative Concepts | $103 | 318% |
| Allegeant | $103 | 318% |
| Ameriben | $103 | 318% |
| American Family | $103 | 318% |
| American Healthcare Alliance | $103 | 318% |
| American National | $103 | 318% |
| American Republic | $103 | 318% |
| Amerihealth | $103 | 318% |
| Aultcare | $103 | 318% |
| Automated Benefit Services | $103 | 318% |
| Auxiant | $103 | 318% |
| Benefit Administrative Systems,Llc | $103 | 318% |
| Boon Chapman | $103 | 318% |
| Cam Administrative Services | $103 | 318% |
| Christian Brother Services | $103 | 318% |
| Christian Brothers Holy Cross | $103 | 318% |
| Comprehensive Benefits | $103 | 318% |
| Continental Life Insurance | $103 | 318% |
| Custom Benefit Administrators | $103 | 318% |
| Employee Benefit Concepts | $103 | 318% |
| Employee Benefit Management | $103 | 318% |
| Enterprise Group Planning | $103 | 318% |
| Freedom Life Insurance Company | $103 | 318% |
| Group Administrators | $103 | 318% |
| Group Marketing Services | $103 | 318% |
| Guardian | $103 | 318% |
| Health America | $103 | 318% |
| Healthcare Management Admin | $103 | 318% |
| Healthez | $103 | 318% |
| Humana | $103 | 318% |
| Insight | $103 | 318% |
| Intercare | $103 | 318% |
| Jfp Benefit Management | $103 | 318% |
| Jp Farley Corporation | $103 | 318% |
| Key Benefit Administrator | $103 | 318% |
| Liberty Union Life Assurance Co | $103 | 318% |
| Lucent Health | $103 | 318% |
| Luminare Health | $103 | 318% |
| Luminare Health (Detroit) | $103 | 318% |
| Magnacare | $103 | 318% |
| Medben | $103 | 318% |
| Medcost | $103 | 318% |
| Medical Mutual | $103 | 318% |
| Mutual Health Services | $103 | 318% |
| Mutual Of Omaha | $103 | 318% |
| Ncas | $103 | 318% |
| Nippon Life Ins | $103 | 318% |
| Nova | $103 | 318% |
| Painters Union Insurance Fund | $103 | 318% |
| Physicians Mutual | $103 | 318% |
| Plumbers Local 98 Insurance Fund | $103 | 318% |
| Prairie States | $103 | 318% |
| Preferred One | $103 | 318% |
| Primary Physician Care | $103 | 318% |
| Professional Benefit Administrators | $103 | 318% |
| Siho Insurance Services | $103 | 318% |
| Sisco Benefits | $103 | 318% |
| The Loomis Company | $103 | 318% |
| Unicare | $103 | 318% |
| Us Health And Life | $103 | 318% |
| Valenz | $103 | 318% |
| Western & Southern Financial Group | $103 | 318% |
| Wps | $103 | 318% |
| Coventry | $106 | 327% |
| First Health | $106 | 327% |
| Hospice Of Michigan | $108 | 333% |
| Cigna | $109 | 336% |
| 1199 National Benefit Fund | $116 | 358% |
| Allied National Global Care | $116 | 358% |
| Asrm - Reliance Standard Life Insurance | $116 | 358% |
| Christian Care Ministry | $116 | 358% |
| Dean Health | $116 | 358% |
| Fallon Health | $116 | 358% |
| Family Life Insurance Company | $116 | 358% |
| Ghc Scw | $116 | 358% |
| Group Pension Administrators | $116 | 358% |
| International Benefit Administrators | $116 | 358% |
| Lifetime Benefit Solutions | $116 | 358% |
| Manhattan Life | $116 | 358% |
| Medi Share | $116 | 358% |
| Multiplan | $116 | 358% |
| Mvp | $116 | 358% |
| Pai | $116 | 358% |
| Pan-American Life | $116 | 358% |
| Paramount Hmo | $116 | 358% |
| Phcs | $116 | 358% |
| Trinity Health Share | $116 | 358% |
| Health Partners | $120 | 370% |
| Tufts Health Plan | $120 | 370% |
| Prime Health Services | $124 | 383% |
| Three Rivers Provider Network | $140 | 432% |
| Cmh Detroit Wayne Integrated Health Network | $155 | 478% |
| Cmh Jackson County/Lifeways | $155 | 478% |
| Cmh Lenawee County | $155 | 478% |
| Cmh Livingston County | $155 | 478% |
| Cmh Misc | $155 | 478% |
| Cmh Monroe County | $155 | 478% |
| Cmh Washtenaw County | $155 | 478% |
| Magellan Behavioral Health | $155 | 478% |