CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Englewood Hospital and Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $95
Cash Discount Price: $20
vs. Medicare Baseline: 2.93x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Englewood Hospital and Medical Center is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.93x the Medicare baseline. Located in 350 Engle St, Englewood, NJ.

Cash / Self-Pay

$20

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $20 (62%)

Insurance Median: $95 (293%)

Cash: $20 (62% of Medicare)

Ins. Median: $95 (293% 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 293% of the Medicare baseline (a markup of 193%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

Out-of-Pocket Cost Estimator

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.

Billing Status

Remaining Deductible ($)

Your Coinsurance 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
Horizon New Jersey Health - Dsnp	$14 - $41	43%
Wellcare_755	$15	46%
Aetna	$16 - $170	49%
Americhoice_756	$18	56%
Amerigroup_754	$19	59%
Emblem_762	$35	108%
Heathnet Federal Services	$38	117%
Multiplan	$38 - $96	117%
Americhoice_732	$41	127%
Amerigroup_758	$41	127%
Amerihealth_766	$41	127%
Blue Cross Blue Shield	$41 - $113	127%
Clover_733	$41	127%
Humana	$41	127%
UnitedHealthcare	$41 - $266	127%
Wellcare_765	$44	136%
Horizon New Jersey Health_674	$60	185%
Health Care Support_787	$71	219%
Amerihealth_760	$73	225%
Amerihealth_757	$90	278%
Magnacare_768	$98	302%
Magnacare_770	$98	302%
Horizon	$114 - $122	352%
Magnacare_763	$117	361%
Magnacare_769	$117	361%
Qualcare_752	$129	398%
Qualcare	$131	404%
Emblem_734	$145	448%
Hip Health Plan	$145	448%
Coventry	$146	451%
Magnacare	$156	481%
Cigna	$184	568%
Oxford_741	$251	775%
Bergen	$329	1015%
Qualcare_783	$7,783	24022%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $20.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Englewood Hospital and Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.