CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Southcoast Hospitals Group

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $42
Cash Discount Price: $63
vs. Medicare Baseline: 1.30x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Southcoast Hospitals Group is $42. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.30x the Medicare baseline. Located in 363 Highland Avenue, Fall River, MA.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$42

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: $63 (194%)

Insurance Median: $42 (130%)

Cash: $63 (194% of Medicare)

Ins. Median: $42 (130% 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
Wellsense Health Plan Clarity Connectorcare & Meta	$27	83%
Medicare (plans)	$31 - $43	96%
Wellsense Health Plan [1010202]	$34	105%
Aetna	$36 - $96	111%
Blue Cross Blue Shield	$36 - $204	111%
Evercare [1010304]	$36	111%
Tufts Senior Care Options [1010315]	$36	111%
UnitedHealthcare	$36 - $183	111%
Wellsense Health Plan Senior Care Options [1020208	$36	111%
Commonwealth Care Alliance [1080501]	$37	114%
Tufts Health Public Plans [1010213]	$39 - $412	120%
Eternal Health [1010322]	$40	123%
Fallon [1000114]	$50	154%
Tufts [1010701]	$53	164%
Mass General Brigham Health Plan Commercial [10122	$71	219%
Mass General Brigham Health Plan Connectorcare [10	$71	219%
Group Insurance Service Center [1013001]	$76	235%
Innovative Health Plan [1025001]	$76	235%
Priority Health [1015001]	$76	235%
PHCS [1000125]	$82	253%
Cigna	$83	256%
Wellpoint [1000102]	$91	281%
First Health [1000130]	$96	296%
Harvard Pilgrim [1010602]	$236	728%

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 $63.
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 Southcoast Hospitals Group 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.