CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Seattle Children's Hospital
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $190
- Cash Discount Price: $457
- vs. Medicare Baseline: 5.86x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Seattle Children's Hospital is $190. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $457. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 5.86x the Medicare baseline. Located in 4800 Sand Point Way Ne, Po Box C-5371, Seattle, WA.
Cash / Self-Pay
$457
Average discount available for prompt cash payment at this facility.
Insurance Median
$190
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: $457 (1410%)
Insurance Median: $190 (586%)
Cash: $457 (1410% of Medicare)
Ins. Median: $190 (586% 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 586% of the Medicare baseline (a markup of 486%). 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 |
|---|---|---|
| Child Hearing League [17301] | $19 | 59% |
| Hospice [17306] | $19 | 59% |
| Maple Lane School [17309] | $19 | 59% |
| Medicaid / KanCare | $19 | 59% |
| Chpw [15802] | $20 | 62% |
| Coordinated Care [15815] | $20 | 62% |
| Eye Quest [15894] | $20 | 62% |
| Icw Wellpoint [15822] | $20 | 62% |
| Kaiser [15818] | $20 | 62% |
| Molina [15809] | $20 | 62% |
| Opticare [15895] | $20 | 62% |
| UnitedHealthcare | $20 - $608 | 62% |
| Wellpoint [15814] | $20 | 62% |
| Ubh Community & State [15819] | $25 | 77% |
| Usfhp [12208] | $81 - $293 | 250% |
| Asuris [11913] | $107 - $386 | 330% |
| Bridgespan Health Company [11906] | $107 - $386 | 330% |
| Premera [11600] | $107 - $594 | 330% |
| Regence [11903] | $107 - $594 | 330% |
| Regence [11909] | $107 - $386 | 330% |
| Chpw Cascade [12228] | $109 - $393 | 336% |
| Coordinated Care [12267] | $109 - $536 | 336% |
| Kaiser [13400] | $109 - $536 | 336% |
| Kaiser [13401] | $129 - $465 | 398% |
| Regence Ump [12263] | $129 - $465 | 398% |
| Administrators [13102] | $149 - $608 | 460% |
| Molina Marketplace [12831] | $149 - $536 | 460% |
| Asuris [11900] | $165 - $594 | 509% |
| Blue Cross Blue Shield | $165 - $594 | 509% |
| Aetna | $167 - $601 | 515% |
| Ameriben [11006] | $167 - $601 | 515% |
| Christian Brothers [11001] | $167 - $601 | 515% |
| Coresource [11004] | $167 - $601 | 515% |
| Ebms [11003] | $167 - $601 | 515% |
| Meritain [12251] | $167 - $680 | 515% |
| Moda [11009] | $167 - $601 | 515% |
| Preferred One [11008] | $167 - $601 | 515% |
| Web Tpa [11007] | $167 - $601 | 515% |
| Allegiance [12264] | $169 - $608 | 522% |
| Allied [13129] | $169 - $608 | 522% |
| Assurant Health Fc [13135] | $169 - $608 | 522% |
| Carpenters Trust [13100] | $169 - $608 | 522% |
| Cigna | $169 - $608 | 522% |
| Coastal Administrative [13140] | $169 - $608 | 522% |
| Coventry Fc [13112] | $169 - $608 | 522% |
| Ebms Fc [13144] | $169 - $608 | 522% |
| First Choice [13399] | $169 - $608 | 522% |
| Guardian Fc [13105] | $169 - $608 | 522% |
| Health Alliance [13233] | $169 - $608 | 522% |
| Ilwu-Pma [13158] | $169 - $608 | 522% |
| Kps [13109] | $169 - $608 | 522% |
| Loomis Benefits West [13161] | $169 - $608 | 522% |
| Mega Life [13111] | $169 - $608 | 522% |
| Meritain Health [13229] | $169 - $608 | 522% |
| Moda Fc [13219] | $169 - $608 | 522% |
| Myers Stevens & Toohey [13169] | $169 - $608 | 522% |
| Pacific Underwriters [13175] | $169 - $608 | 522% |
| Personify Fc [13155] | $169 - $608 | 522% |
| Personify [12270] | $169 - $608 | 522% |
| Principal Mutual Fc [13115] | $169 - $608 | 522% |
| Providence Health Plan [12289] | $169 - $608 | 522% |
| Providence Health Plan [13181] | $169 - $608 | 522% |
| Psew [13124] | $169 - $608 | 522% |
| Rehn & Associates [13182] | $169 - $608 | 522% |
| Sound Health And Wellness [13116] | $169 - $608 | 522% |
| Starmark [13103] | $169 - $608 | 522% |
| Tongass Timber Trust [13202] | $169 - $608 | 522% |
| Trusteed Plans [13186] | $169 - $608 | 522% |
| Trustmark Life Insurance [13203] | $169 - $608 | 522% |
| Tufts Health Plan [12279] | $169 - $608 | 522% |
| Welfare Pension [13120] | $169 - $608 | 522% |
| Wship [13121] | $169 - $608 | 522% |
| Zenith American Solutions [13195] | $169 - $608 | 522% |
| Zenith [13123] | $169 - $608 | 522% |
| United Behavioral Health [12234] | $174 - $629 | 537% |
| Coastal Admin Svcs Contracted [12222] | $178 - $644 | 549% |
| Personify Contracted [12205] | $178 - $644 | 549% |
| Claritev [12299] | $188 - $680 | 580% |
| Ebms [12241] | $188 - $680 | 580% |
| Health Alliance [12266] | $188 - $680 | 580% |
| Humana | $188 - $680 | 580% |
| Key Benefit Admin [12276] | $188 - $680 | 580% |
| Medical Mutual [12233] | $188 - $680 | 580% |
| Moda [12842] | $188 - $680 | 580% |
| Nippon Life Insurance [12232] | $188 - $680 | 580% |
| Pehp [12235] | $188 - $680 | 580% |
| Preferredone Admin Services [12236] | $188 - $680 | 580% |
| Select Health [12277] | $188 - $680 | 580% |
| Altius Health Plan [12275] | $190 - $687 | 586% |
| Coventry Mhbp [12272] | $190 - $687 | 586% |
| Coventry [12244] | $190 - $687 | 586% |
| First Health [12210] | $190 - $687 | 586% |
| Hcc Medical [12274] | $190 - $687 | 586% |
| Lewermark [12286] | $190 - $687 | 586% |
| Medishare [12287] | $190 - $687 | 586% |
| Pacificsource [12245] | $190 - $687 | 586% |
| Rural Carrier Benefit Plan [12271] | $190 - $687 | 586% |