Occupational therapy (self-care training)
Facility: Chester County Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $79
- Cash Discount Price: $254
- vs. Medicare Baseline: 2.44x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 244% of the Medicare baseline (a markup of 144%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Health Partners | $22 - $254 | 68% |
| UnitedHealthcare | $28 - $167 | 86% |
| Hospice Vna | $33 | 102% |
| Medicare (plans) | $33 - $34 | 102% |
| Primecare Medical | $33 | 102% |
| Tricare | $33 | 102% |
| Us Family Health Plan | $33 | 102% |
| Va Medical Center | $33 | 102% |
| Cigna | $34 - $254 | 105% |
| Humana | $34 | 105% |
| Aetna | $35 - $81 | 108% |
| Clover Health Plan | $35 | 108% |
| Devoted Health | $35 | 108% |
| Pa Health And Wellness | $35 - $55 | 108% |
| Keystone First Vip Choice | $37 | 114% |
| Mva Insurance | $37 | 114% |
| Gateway | $41 | 127% |
| Elap | $47 | 145% |
| Keystone First | $51 | 157% |
| Claims Watcher | $53 - $60 | 164% |
| Oscar Health Plan | $57 | 176% |
| Pgm - Regie De L'Assurance Maladie Quebec | $58 | 179% |
| Centivo | $60 | 185% |
| Elap Services | $62 | 191% |
| Medicaid / KanCare | $64 - $254 | 198% |
| Highmark | $69 | 213% |
| Ibc | $71 - $80 | 219% |
| Keystone Hmo Proactive | $71 | 219% |
| Todays Option | $71 | 219% |
| Preferred Health Care Eliance | $79 | 244% |
| Penn Global Medicine | $89 | 275% |
| Pgm - Kuwait Defense | $89 - $114 | 275% |
| Qualcare | $97 | 299% |
| Pgm - Chop | $102 | 315% |
| Geisinger Health Plan | $106 | 327% |
| Medrisk | $130 - $254 | 401% |
| Pgm - Royal Embassy Of Saudi Arabia | $152 | 469% |
| Pgm - Embassy Of Qatar | $165 | 509% |
| Pgm - Ontario Ministry Of Health And Long-Term Care (Ohip) | $165 | 509% |
| Pgm - Embassy Of The United Emirates/Ipc | $178 | 549% |
| Healthamerica/Coventry | $190 | 586% |
| Pgm - Kuwait Health Division | $203 | 627% |
| Pgm - Kuwait Oil | $203 | 627% |
| Preferred Health Care | $203 | 627% |
| Intergroup | $216 | 667% |
| Olympus | $222 | 685% |
| International Pfs | $254 | 784% |
| La Comunidad Hispana | $254 | 784% |
| Not Adjusted | $254 | 784% |
| Workers Compensation | $254 | 784% |