CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Clarion Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $51
Cash Discount Price: $80
vs. Medicare Baseline: 1.57x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Clarion Hospital is $51. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.57x the Medicare baseline. Located in One Hospital Drive, Clarion, PA.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$51

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: $80 (247%)

Insurance Median: $51 (157%)

Cash: $80 (247% of Medicare)

Ins. Median: $51 (157% 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
Upmc	$15 - $106	46%
Highmark	$25 - $72	77%
Highmark - Ind.& Managed Care	$25 - $72	77%
Martin'S Point - Usfhp	$26 - $74	80%
Gateway	$27 - $78	83%
Devoted Health Plan	$29 - $84	90%
Amerihealth	$31	96%
Cigna	$31 - $106	96%
Highmark Community Blue	$31	96%
Medicare (plans)	$31	96%
Tricare	$31	96%
UnitedHealthcare	$31	96%
Aetna	$32 - $188	99%
Geisinger	$32	99%
Pa Health & Wellness	$33	102%
The Health Plan	$33 - $72	102%
American Health Plan	$34	105%
Workers Comp	$44 - $196	136%
Peak Health	$51 - $148	157%
Devon	$55 - $158	170%

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 $80.
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 Clarion Hospital 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.