CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $115
Cash Discount Price: $220
vs. Medicare Baseline: 3.55x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at UMass Memorial Healthalliance Hospitals is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $220. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.55x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$220

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $220 (679%)

Insurance Median: $115 (355%)

Cash: $220 (679% of Medicare)

Ins. Median: $115 (355% 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 355% of the Medicare baseline (a markup of 255%). 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
Workers Compensation [20501]	$25	77%
Champva [11001]	$33	102%
Cigna	$33 - $96	102%
Correctional Care [11003]	$33 - $53	102%
Institution [10406]	$33 - $119	102%
Medicare (plans)	$33	102%
Tufts Dual [10111]	$33	102%
Tufts Us Family [11203]	$33	102%
Aetna	$35 - $147	108%
Blue Cross Blue Shield	$35 - $249	108%
Fallon Mcr Supp [20202]	$35	108%
Tufts Mcr [10112]	$35	108%
UnitedHealthcare	$35 - $225	108%
Commonwealth Care Mcr [10115]	$36	111%
Harvard Pilgrim Mcr [10106]	$36	111%
Mgb Mcr [10124]	$36	111%
Senior Whole Health [10110]	$36	111%
Tufts Connectorcare [10507]	$58	179%
Wellpoint [11112]	$77	238%
Medicaid / KanCare	$84 - $117	259%
Tufts [11201]	$87	269%
Hne [11108]	$119 - $126	367%
First Health Network [11120]	$160 - $169	494%
Multiplan [11109]	$160 - $169	494%
Fallon Connectorcare [10503]	$181	559%
Harvard Pilgrim [10701]	$185 - $222	571%
Connecticare [11105]	$214 - $225	660%
Fallon Carelon Hlth [28]	$214 - $225	660%
Fallon Mcaid Carelon Hlth [29]	$214 - $225	660%
Grants [20507]	$214 - $225	660%
Hsno/Free Care [10801]	$294	907%

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 $220.
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 UMass Memorial Healthalliance Hospitals 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.