CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Frisbie Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $41
Cash Discount Price: $154
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Frisbie Memorial Hospital is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $154. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.27x the Medicare baseline. Located in 11 Whitehall Road, Rochester, NH.

Cash / Self-Pay

$154

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $154 (475%)

Insurance Median: $41 (127%)

Cash: $154 (475% of Medicare)

Ins. Median: $41 (127% 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 Caritas	$13	40%
Well Sense Health Plan	$19	59%
Aetna	$29 - $89	90%
Blue Cross Blue Shield	$29 - $62	90%
Humana	$29 - $33	90%
United VA Ccn	$29 - $33	90%
Cigna	$30 - $34	93%
Evernorth Behavioral Health	$30 - $34	93%
Martin's Point Health	$30 - $34	93%
United	$30 - $93	93%
Harvard Pilgrim	$41 - $62	127%
Maine Community Health	$44 - $74	136%
Ambetter / Centene	$52 - $59	160%
Tufts Health Plan	$53 - $88	164%
Evernorth	$123	380%

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 $154.
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 Frisbie Memorial 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.