CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Washington Hospital, The

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $58
Cash Discount Price: $70
vs. Medicare Baseline: 1.79x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Washington Hospital, The is $58. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $70. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.79x the Medicare baseline. Located in 155 Wilson Avenue, Washington, PA.

Cash / Self-Pay

$70

Average discount available for prompt cash payment at this facility.

Insurance Median

$58

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: $70 (216%)

Insurance Median: $58 (179%)

Cash: $70 (216% of Medicare)

Ins. Median: $58 (179% 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.

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
Aetna	$23 - $60	71%
Upmc Health Plan	$36 - $37	111%
Highmark Wholecare (Prev Gateway)	$46 - $54	142%
Cigna	$64 - $65	198%
Health Plan Of Upper Ohio Valley	$72 - $74	222%
Peak Health	$74 - $76	228%
Coventry/First Health	$76 - $78	235%

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 $70.
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 Washington Hospital, The 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.