CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Berkshire Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $68
Cash Discount Price: $89
vs. Medicare Baseline: 1.94x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Berkshire Medical Center is $68. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.94x the Medicare baseline. Located in 725 North Street, Pittsfield, MA.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$68

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: $89 (254%)

Insurance Median: $68 (194%)

Cash: $89 (254% of Medicare)

Ins. Median: $68 (194% 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.

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
Cdphp	$29 - $84	83%
Health New England	$29 - $75	83%
Mcd Out Of State	$29 - $73	83%
Medicaid / KanCare	$29 - $73	83%
Comm Tufts Qhpsub (Network)	$32 - $53	91%
Point32Health	$32 - $89	91%
Bmchnp	$33 - $95	94%
Hospice	$36	103%
Medicare (plans)	$36	103%
Other Government	$36	103%
UnitedHealthcare	$36 - $80	103%
Blue Cross Blue Shield	$38 - $80	108%
Commcare Alliance	$38 - $43	108%
Fallon	$38 - $72	108%
Aetna	$43 - $71	123%
Workers Comp	$57	163%
Allways Nhp	$61	174%
Unicare	$61 - $74	174%
Comm Hne Hmo	$65 - $70	185%
Comm Hne Ppo	$69 - $75	197%
Mbhp	$73	208%
Beacon	$80 - $84	228%
Cigna	$84 - $87	240%
Mvp	$84	240%
Oxford	$84	240%
First Health	$87 - $89	248%
Connecticare	$89	254%
Consolidated Health Plans	$89	254%
Other Commercial	$89	254%
Phcs	$89	254%
Self Pay	$89	254%

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 $89.
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 Berkshire Medical Center 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.