CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Boston Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $40
Cash Discount Price: $151
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Boston Medical Center is $40. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $151. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.23x the Medicare baseline. Located in 1 Boston Medical Center Place, Boston, MA.

Cash / Self-Pay

$151

Average discount available for prompt cash payment at this facility.

Insurance Median

$40

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: $151 (466%)

Insurance Median: $40 (123%)

Cash: $151 (466% of Medicare)

Ins. Median: $40 (123% 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.

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 Comp [5002]	$25	77%
Zzzbu Employee Work Comp [5004]	$25	77%
Zzzcity Of Boston Work Comp [5003]	$25	77%
Aetna	$36 - $164	111%
Blue Cross Blue Shield	$36 - $216	111%
Humana	$36	111%
Medicare (plans)	$36 - $38	111%
Neighborhood Pace [1206]	$36	111%
Oxford Health [1007]	$36	111%
Oxford Health [2024]	$36	111%
Tufts [8002]	$36 - $106	111%
Ubh Hphc [8016]	$36	111%
United [2025]	$36 - $145	111%
UnitedHealthcare	$36	111%
Veterans Admin [9003]	$36	111%
Zzzcovid19 Hrsa Uninsured Testing And Treatment Fund [500010]	$36	111%
Zzzunited [1008]	$36 - $145	111%
Champva [9004]	$37	114%
Tricare	$37	114%
Cca [1215]	$38	117%
Corrections [9001]	$38 - $45	117%
Eternalhealth [1227]	$38	117%
Wellcare [1240]	$38	117%
Zzzcca Onecare [1216]	$38	117%
Fallon Sco [1126]	$40	123%
Senior Whole Health [1210]	$44	136%
Fallon [8008]	$47	145%
Tufts Conncare/Qhp [8020]	$52 - $431	160%
Unicare [8004]	$52	160%
Wellpoint [2034]	$52	160%
Cigna	$106 - $285	327%
Medicaid / KanCare	$121	373%
Uphams Corner Esp [1213]	$134	414%
Harvard Pilgrim Health Care [8001]	$145	448%
Health Plans Inc [2027]	$145	448%
Zzzhealth Plans Inc [1013]	$145	448%
Meritain Health [1023]	$164	506%
Mass General Brigham Health Plan Commercial [8009]	$181	559%
Hsn Bad Debt [4003]	$513	1583%
Hsn Confidential [4007]	$513	1583%
Hsn Dental [4006]	$513	1583%
Hsn Partial [4002]	$513	1583%
Hsn [4001]	$513	1583%

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 $151.
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 Boston Medical Center 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.