CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Atlantic Rehabilitation Institute, LLC

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $140
Cash Discount Price: $140
vs. Medicare Baseline: 4.32x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Atlantic Rehabilitation Institute, LLC is $140. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $140. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.32x the Medicare baseline. Located in 200 Madison Ave, Madison, NJ.

Cash / Self-Pay

$140

Average discount available for prompt cash payment at this facility.

Insurance Median

$140

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: $140 (432%)

Insurance Median: $140 (432%)

Cash: $140 (432% of Medicare)

Ins. Median: $140 (432% 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 432% of the Medicare baseline (a markup of 332%). 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
Qualcare Lynx Wc Cpd	$78 - $350	241%
First Managed Care Wc Cpd	$78 - $350	241%
All Savers Cpd	$78 - $350	241%
UnitedHealthcare	$78 - $350	241%
Aetna	$78 - $350	241%
Oscar Health Cpd	$78 - $350	241%
Amerihealth Cpd	$78 - $350	241%
Wellcare Mgg	$78 - $350	241%
Medicaid / KanCare	$78 - $350	241%
Oxford Mgg	$78 - $350	241%
Braven Health Cpd	$78 - $350	241%
Amerihealth Mgg	$78 - $350	241%
Blue Cross Blue Shield	$78 - $350	241%
Ama Insurance Msg	$78 - $350	241%
Braven Health Mgd	$78 - $350	241%
Claim Doc LLC Cpd	$78 - $350	241%
Gateway Mgg	$78 - $350	241%
Cigna	$78 - $350	241%
Qualcare Cpd	$78 - $350	241%
Oxford Health Plan Cpd	$78 - $350	241%
UPMC for Life Mgg	$78 - $350	241%
Amerigroup Mgg (Wellpoint As of 5/1/24)	$78 - $350	241%
Ambetter / Centene	$78 - $350	241%

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 $140.
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 Atlantic Rehabilitation Institute, LLC 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.