CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Boston Children's Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $148
Cash Discount Price: $209
vs. Medicare Baseline: 4.57x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Boston Children's Hospital is $148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $209. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.57x the Medicare baseline. Located in 300 Longwood Avenue, Boston, MA.

Cash / Self-Pay

$209

Average discount available for prompt cash payment at this facility.

Insurance Median

$148

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: $209 (645%)

Insurance Median: $148 (457%)

Cash: $209 (645% of Medicare)

Ins. Median: $148 (457% 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 457% of the Medicare baseline (a markup of 357%). 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
Cdphp	$102 - $178	315%
Harvard Pilgrim	$106 - $141	327%
Unicare	$116	358%
Blue Cross Blue Shield	$118 - $138	364%
Aetna	$125 - $175	386%
United	$125 - $175	386%
Mgb/Allways	$127 - $155	392%
Tufts Public Plan	$128 - $129	395%
Ambetter / Centene	$132	407%
United Ri Nj Ny	$132	407%
Carelon Strategies/Bhs	$136	420%
UnitedHealthcare	$136 - $178	420%
Carelon/Beacon	$157	485%
Fallon	$159 - $161	491%
Health New England	$169	522%
Cigna	$178 - $189	549%
Ets/Lifetrac	$178	549%
Interlink Transplant	$178	549%
Community Health Options	$188	580%
Humana	$188	580%
Coventry/Hcvm/First Health	$192	593%
Multiplan/Phcs	$192 - $199	593%

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 $209.
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 Children's 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.