CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: UMass Memorial Health - Harrington Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $142
Cash Discount Price: $174
vs. Medicare Baseline: 4.38x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at UMass Memorial Health - Harrington Hospital is $142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $174. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.38x the Medicare baseline. Located in 100 South Street, Southbridge, MA.

Cash / Self-Pay

$174

Average discount available for prompt cash payment at this facility.

Insurance Median

$142

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: $174 (537%)

Insurance Median: $142 (438%)

Cash: $174 (537% of Medicare)

Ins. Median: $142 (438% 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 438% of the Medicare baseline (a markup of 338%). 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%
Cigna	$26 - $146	80%
Champva [11001]	$33	102%
Institution [10406]	$33	102%
Mgb Mcr [10124]	$33	102%
Tufts Us Family [11203]	$33	102%
Aetna	$35 - $206	108%
Blue Cross Blue Shield	$35 - $243	108%
Fallon Mcr Supp [20202]	$35	108%
Fallon Mcr [10105]	$35	108%
Tufts Mcr [10112]	$35	108%
UnitedHealthcare	$35 - $206	108%
Commonwealth Care Alliance [10103]	$36	111%
Senior Whole Health [10110]	$36	111%
Tufts Connectorcare [10507]	$58	179%
Medicaid / KanCare	$74 - $107	228%
Wellpoint [11112]	$77	238%
Hne [11108]	$92 - $134	284%
Tufts [11201]	$101 - $146	312%
First Health Network [11120]	$106 - $154	327%
Evernorth Behavioral Health [27]	$114 - $165	352%
Connecticare [11105]	$142 - $206	438%
Fallon Carelon Hlth [28]	$142 - $206	438%
Fallon Mcaid Carelon Hlth [29]	$142 - $206	438%
Grants [20507]	$142 - $206	438%
Masshealth Mcd Mbhp [38]	$142 - $206	438%
Wellsense Mcaid Carelon Hlth [21]	$142 - $206	438%
Fallon Connectorcare [10503]	$181	559%
Harvard Pilgrim [10701]	$202 - $242	623%
Hsno/Free Care [10801]	$681	2102%

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 $174.
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 Health - Harrington Hospital 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.