CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Hackensack Meridian Health Pascack Valley Medical

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $162
Cash Discount Price: $45
vs. Medicare Baseline: 5.00x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Hackensack Meridian Health Pascack Valley Medical is $162. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 5.00x the Medicare baseline. Located in 250 Old Hook Road, Westwood, NJ.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$162

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: $45 (139%)

Insurance Median: $162 (500%)

Cash: $45 (139% of Medicare)

Ins. Median: $162 (500% 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 500% of the Medicare baseline (a markup of 400%). 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
UnitedHealthcare	$15 - $178	46%
Healthscope Benefits [2290]	$15 - $162	46%
Medicaid / KanCare	$28 - $29	86%
Medicare (plans)	$34	105%
Aetna	$42	130%
Worker's Comp [2125]	$78	241%
Selecthealth [3740]	$78	241%
Oncology Patient Assistance Programs [2295]	$78	241%
Commercial Generic [1285]	$78	241%
Web Tpa [2115]	$78	241%
Horizon [3625]	$78 - $178	241%
Wtc Healthcare Sme Karna [8005]	$78	241%
Lucent Health [6000]	$78	241%
Create Flex / Select [3580]	$78	241%
Black Lung [6055]	$78	241%
Healthcare Highways [2210]	$78 - $162	241%
Qualcare [3725]	$160 - $185	494%
Gilsbar [1425]	$162	500%
Hometown Health [2155]	$162	500%
Mutual of Omaha [1685]	$162	500%
Resource One Administrators [2815]	$162	500%
Healthfirst [2395]	$162	500%
Planned Administrators Inc [2360]	$162	500%
Multiplan [1680]	$162	500%
New Era Life Insurance Company [1705]	$162	500%
Healthnet [1495]	$162	500%
Pba [1775]	$162	500%
Universal Fidelity [2085]	$162	500%
Healthcost Solutions [2415]	$162	500%
PHCS [1780]	$162	500%
Pan American Life Insurance Co [1770]	$162	500%
First Health [1375]	$162	500%
Trustmark [2030]	$162	500%
Mayo Clinic Health Solutions [2280]	$162	500%
Administrative Concepts [1005]	$162	500%
Allied National Global Care [1035]	$162	500%
Blue Cross Blue Shield	$178	549%
Emblem Health [2430]	$185	571%
Humana	$185	571%
Amerihealth [3520]	$190	586%

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 $45.
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 Hackensack Meridian Health Pascack Valley Medical 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.