CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Transylvania Regional Hospital, Inc

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $47
Cash Discount Price: $116
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Transylvania Regional Hospital, Inc is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.45x the Medicare baseline. Located in 90 Hospital Drive Po Box 1116, Brevard, NC.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $116 (358%)

Insurance Median: $47 (145%)

Cash: $116 (358% of Medicare)

Ins. Median: $47 (145% 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
Amerihealth	$22 - $23	68%
Blue Cross Blue Shield	$22 - $24	68%
United	$22 - $53	68%
Wellcare	$22 - $23	68%
Apex Health	$23 - $24	71%
Partners Health Management	$23	71%
Vaya Health	$23	71%
Aetna	$30 - $86	93%
Cigna	$42 - $60	130%
Amerihealth Caritas	$47 - $49	145%
Caresource	$50 - $52	154%
Medcost	$64 - $101	198%
Magellan	$68 - $71	210%
Magellan Behavioral Health	$68 - $71	210%
Multiplan	$91 - $95	281%
Avalon Administrative Services	$97 - $101	299%
Prime Health	$100 - $107	309%

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 $116.
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 Transylvania Regional Hospital, Inc 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.