CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Fairview Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $62
Cash Discount Price: $90
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Fairview Hospital is $62. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.91x the Medicare baseline. Located in 29 Lewis Avenue, Great Barrington, MA.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$62

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: $90 (278%)

Insurance Median: $62 (191%)

Cash: $90 (278% of Medicare)

Ins. Median: $62 (191% 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
Health New England	$25 - $69	77%
Medicaid / KanCare	$25 - $65	77%
Aetna	$26 - $72	80%
Point32Health	$28 - $90	86%
Bmchnp	$29 - $67	90%
Hospice	$33 - $37	102%
Medicare (plans)	$33 - $37	102%
Other Government	$33 - $37	102%
UnitedHealthcare	$33 - $82	102%
Fallon	$35 - $42	108%
Commcare Alliance	$36 - $40	111%
Blue Cross Blue Shield	$37 - $81	114%
Comm Fallon Qhp	$50 - $59	154%
Workers Comp	$61	188%
Allways Nhp	$62	191%
Comm Hne Hmo	$62 - $66	191%
Unicare	$62 - $74	191%
Comm Hne Ppo	$66 - $70	204%
Capital District Physicians' Health Plan	$86	265%
Cigna	$86 - $89	265%
Mvp	$86	265%
Oxford	$86	265%
First Health	$89 - $90	275%
Connecticare	$90	278%
Consolidated Health Plans	$90	278%
Other Commercial	$90	278%
Phcs	$90	278%
Self Pay	$90	278%

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 $90.
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 Fairview 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.