CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: UMass Memorial Healthalliance Hospitals

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $98
Cash Discount Price: $243
vs. Medicare Baseline: 2.79x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at UMass Memorial Healthalliance Hospitals is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $243. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.79x the Medicare baseline. Located in 60 Hospital Road, Leominster, MA.

Cash / Self-Pay

$243

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $243 (693%)

Insurance Median: $98 (279%)

Cash: $243 (693% of Medicare)

Ins. Median: $98 (279% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 279% of the Medicare baseline (a markup of 179%). 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	71%
Champva [11001]	$28	80%
Cigna	$36 - $110	103%
Correctional Care [11003]	$36 - $57	103%
Institution [10406]	$36 - $129	103%
Medicare (plans)	$36	103%
Tufts Dual [10111]	$36	103%
Tufts Us Family [11203]	$36	103%
Aetna	$38 - $159	108%
Fallon Mcr Supp [20202]	$38	108%
Tufts Mcr [10112]	$38	108%
UnitedHealthcare	$38 - $243	108%
Blue Cross Blue Shield	$39 - $249	111%
Commonwealth Care Mcr [10115]	$40	114%
Harvard Pilgrim Mcr [10106]	$40	114%
Mgb Mcr [10124]	$40	114%
Senior Whole Health [10110]	$41	117%
Tufts Connectorcare [10507]	$65	185%
Wellpoint [11112]	$76	217%
Medicaid / KanCare	$84 - $126	240%
Tufts [11201]	$100	285%
Hne [11108]	$136	388%
First Health Network [11120]	$182	519%
Multiplan [11109]	$182	519%
Harvard Pilgrim [10701]	$185 - $222	528%
Fallon Connectorcare [10503]	$202	576%
Connecticare [11105]	$243	693%
Fallon Carelon Hlth [28]	$243	693%
Fallon Mcaid Carelon Hlth [29]	$243	693%
Grants [20507]	$243	693%
Hsno/Free Care [10801]	$294	838%

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 $243.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

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 97530.
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.