CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Arnot Ogden Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $98
Cash Discount Price: $135
vs. Medicare Baseline: 3.02x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Arnot Ogden Medical Center is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $135. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.02x the Medicare baseline. Located in 600 Roe Avenue, Elmira, NY.

Cash / Self-Pay

$135

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

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: $135 (417%)

Insurance Median: $98 (302%)

Cash: $135 (417% of Medicare)

Ins. Median: $98 (302% 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 302% of the Medicare baseline (a markup of 202%). 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
Empire	$16	49%
Blue Cross Blue Shield	$25 - $2,324	77%
Aetna	$28 - $575	86%
Fidelis	$28 - $46	86%
Geisinger	$28 - $83	86%
Icircle	$28	86%
UnitedHealthcare	$28 - $529	86%
Humana	$31 - $689	96%
Tricare	$31	96%
Amerihealth Mcr Adv - All Plans	$32	99%
Fidelis Care-Exchange - All Plans	$70 - $421	216%
Geisinger - All Plans	$74 - $446	228%
Cigna	$79 - $477	244%
Mvp Health Plan - All Plans	$79 - $477	244%
Independent Health - All Plans	$82 - $498	253%
Upmc Health Plan - All Plans	$88 - $529	272%
Pomco Inc - All Plans	$91 - $552	281%
Emblem Health - All Plans	$112 - $674	346%
Emblem/Ghi	$125	386%
Martins Point Mcr Adv - All Plans	$127 - $766	392%
Healthnow - All Plans	$382 - $2,308	1179%

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 $135.
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 Arnot Ogden Medical Center 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.