CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: AHS Hospital Corp
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $138
- Cash Discount Price: $203
- vs. Medicare Baseline: 4.26x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at AHS Hospital Corp is $138. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $203. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.26x the Medicare baseline. Located in 651 Willow Grove St, Hackettstown, NJ.
Cash / Self-Pay
$203
Average discount available for prompt cash payment at this facility.
Insurance Median
$138
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: $203 (627%)
Insurance Median: $138 (426%)
Cash: $203 (627% of Medicare)
Ins. Median: $138 (426% 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 426% of the Medicare baseline (a markup of 326%). 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 |
|---|---|---|
| Karen Ann Quinlan [5285] | $29 | 90% |
| Tricare | $29 - $31 | 90% |
| Blue Cross Blue Shield | $30 - $135 | 93% |
| Medicaid / KanCare | $30 - $34 | 93% |
| Champva [5354] | $31 | 96% |
| Us Family Health Plan [5258] | $31 | 96% |
| Untd Hlth Community Plan Behavioral Health [5293] | $33 | 102% |
| Untd Hlth Community Plan [5034] | $33 | 102% |
| Cosmetic Surgery/Lap Band/Gastric Bypass [5289] | $34 | 105% |
| Specialty Imaging [5433] | $34 | 105% |
| Aetna | $36 - $175 | 111% |
| Ambetter / Centene | $36 | 111% |
| Amerihealth Administrators Supplemental [5512] | $36 | 111% |
| Amerihealth Caritas Vip Care Ip Splits [5460] | $36 | 111% |
| Amerihealth Caritas Vip Care [5313] | $36 | 111% |
| Amerihealth Medigap [5049] | $36 | 111% |
| Cigna | $36 - $138 | 111% |
| Claim Watcher/Homestead [5488] | $36 - $155 | 111% |
| Claimdoc [5434] | $36 | 111% |
| Fairos [5491] | $36 | 111% |
| Highmark Wholecare Health Plan Ip Splits [5464] | $36 | 111% |
| Highmark Wholecare Health Plan [5413] | $36 | 111% |
| Luminare Health AHS Retiree [5013] | $36 | 111% |
| Medicare (plans) | $36 - $37 | 111% |
| Sedgwick Wtc Health Program Wc [5514] | $36 | 111% |
| UPMC [5455] | $36 | 111% |
| VA Community Care Network [5403] | $36 | 111% |
| Wellcare Behavioral Health [5335] | $36 | 111% |
| Wellcare Health Plans Ip Splits [5475] | $36 | 111% |
| Wellcare Health Plans [5269] | $36 | 111% |
| Kindred Giralda Hospital [5341] | $40 | 123% |
| Wtc Health Program [5273] | $56 | 173% |
| One Call Workers Comp [5418] | $68 | 210% |
| Medrisk/Spnet Worker's Comp [5452] | $75 - $150 | 231% |
| Horizon Nj Health [5021] | $92 | 284% |
| First Managed Care Option [5109] | $94 - $264 | 290% |
| Gallagher Bassett Workers Comp [5117] | $109 | 336% |
| Liberty Mutual Worker's Comp [5174] | $109 | 336% |
| Pma Workers Comp [5224] | $109 | 336% |
| Sedgwick [5235] | $109 | 336% |
| Sentry Worker's Comp [5489] | $109 | 336% |
| Travelers Workers Compensation [5250] | $109 | 336% |
| Evolution Healthcare [5438] | $125 - $175 | 386% |
| Healthez [5445] | $125 - $175 | 386% |
| Mvp Health Care [5197] | $125 | 386% |
| Nalc [5198] | $125 | 386% |
| Seafarers Health and Benefits Plan [5343] | $125 | 386% |
| Tufts Health Plan [5344] | $125 | 386% |
| Webtpa [5447] | $125 - $175 | 386% |
| Centivo [5405] | $134 - $142 | 414% |
| Prime Healthcare [5435] | $135 | 417% |
| Allied Benefit Systems [5046] | $138 - $175 | 426% |
| Iaa - Insurance Administrators of America [5482] | $138 | 426% |
| Occunet [5490] | $138 | 426% |
| The Fairly Group [5528] | $138 | 426% |
| Ghi Emblem Health [5122] | $140 - $150 | 432% |
| Humana | $140 - $150 | 432% |
| Ila Local 1478-2 Welfare Fund [5448] | $140 - $150 | 432% |
| Oscar [5213] | $140 - $150 | 432% |
| Qualcare [5026] | $140 - $182 | 432% |
| Oxford Behavioral Health [5291] | $141 - $148 | 435% |
| Oxford [5024] | $141 - $148 | 435% |
| UnitedHealthcare | $141 - $152 | 435% |
| Inservco Workers Compensation [5158] | $145 - $264 | 448% |
| Medlogix/Consumer Health Network (Chn) [5415] | $145 - $264 | 448% |
| Apwu Healthcare [5053] | $146 - $152 | 451% |
| Geha [5119] | $146 - $152 | 451% |
| Golden Rule Insurance [5124] | $146 - $152 | 451% |
| Harvard Pilgrim Healthcare [5133] | $146 - $152 | 451% |
| Ntca [5208] | $146 - $152 | 451% |
| Surest [5437] | $146 - $152 | 451% |
| Magnacare [5177] | $154 - $248 | 475% |
| Continental Assurance - PHCS [5092] | $170 | 525% |
| Continental Casualty PHCS [5094] | $170 | 525% |
| Coresource [5014] | $170 | 525% |
| Kaiser Permanente [5162] | $170 | 525% |
| Private Healthcare Systems PPO (PHCS) [5227] | $170 | 525% |
| 1199 Seiu Benefit and Pension [5037] | $175 | 540% |
| Banner Health Network [5510] | $175 | 540% |
| Boon-Chapman [5441] | $175 | 540% |
| Christian Brothers Services [5439] | $175 | 540% |
| Church Mutual Wc Insurance Company [5524] | $175 | 540% |
| Continental Assurance [5091] | $175 | 540% |
| Hanover Workers Comp [5130] | $175 | 540% |
| Hartford Worker's Compensation [5132] | $175 | 540% |
| Hcs Network Solutions [5148] | $175 | 540% |
| Healthsmart Benefit Solutions [5446] | $175 | 540% |
| Luminare Health Benefits [5483] | $175 | 540% |
| Marpai Health [5449] | $175 | 540% |
| Meritain Health [5185] | $175 | 540% |
| Nippon Benefit Life [5201] | $175 | 540% |
| Nj Manufacturers Workers Comp [5204] | $175 | 540% |
| Selective Ins Workers Comp [5237] | $175 | 540% |
| Starmark [5240] | $175 | 540% |
| Strategic Comp [5518] | $175 | 540% |
| Zurich Workers Comp [5275] | $175 | 540% |
| Allstate [5047] | $185 | 571% |
| Esurance No Fault [5105] | $185 | 571% |
| Geico No Fault [5120] | $185 | 571% |
| Hanover No Fault [5129] | $185 | 571% |
| Liberty Mutual No Fault [5173] | $185 | 571% |
| Nj Manufacturers No Fault [5203] | $185 | 571% |
| Progressive No Fault [5229] | $185 | 571% |
| State Farm No Fault [5241] | $185 | 571% |
| Travelers No Fault [5249] | $185 | 571% |
| Usaa No Fault [5260] | $185 | 571% |
| Zurich No Fault [5274] | $185 | 571% |
| Occunet Secondary [5517] | $186 | 574% |
| Praxis Workers Comp [5515] | $186 - $232 | 574% |
| The Fairly Group Secondary [5531] | $186 | 574% |
| Amerihealth [5008] | $192 - $204 | 593% |
| First Health Network [5108] | $202 | 623% |
| Independence Bc [5479] | $204 | 630% |
| Multiplan [5194] | $217 | 670% |
| Aig Workers Compensation [5045] | $232 | 716% |
| Amtrust North America Inc [5521] | $232 | 716% |
| Berkshire Hathaway Guard Insurance Company [5529] | $232 | 716% |
| Broadspire Workers Comp [5357] | $232 | 716% |
| Ccmsi Wc [5525] | $232 | 716% |
| Nationwide Mutual Insurance Company [5526] | $232 | 716% |
| Qual-Lynx Wc Preferred [5230] | $232 | 716% |
| Qual-Lynx Wc Standard [5028] | $232 | 716% |
| Sage Adjusting, LLC [5527] | $232 | 716% |
| High Point No Fault [5146] | $248 | 765% |
| Medlogix/Consumer Health Network Pip (Chn) [5414] | $248 | 765% |
| Plymouth Rock Assurance No Fault [5222] | $248 | 765% |
| Chubb Worker's Compensation [5075] | $264 | 815% |
| Claims Resolution Corporation Inc [5520] | $264 | 815% |
| Corvel Corporation [5522] | $264 | 815% |
| Esis [5519] | $264 | 815% |
| Atlantic Home Care and Hospice [5055] | $310 | 957% |
| Bundled Cases/Episodic Payment [5492] | $310 | 957% |
| Carba R Generic [5530] | $310 | 957% |
| Carisk Worker's Comp [5501] | $310 | 957% |
| Streamline Worker's Comp [5540] | $310 | 957% |