CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Bertrand Chaffee Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $32
Cash Discount Price: $63
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Bertrand Chaffee Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $63. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.99x the Medicare baseline. Located in 224 East Main Street, Springville, NY.

Cash / Self-Pay

$63

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $63 (194%)

Insurance Median: $32 (99%)

Cash: $63 (194% of Medicare)

Ins. Median: $32 (99% 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
Univera Essential Plans	$27	83%
Univera Hc Child Health+	$27	83%
Univera Hc Myhealth+	$27	83%
Univera Plus Med	$27	83%
Blue Cross Blue Shield	$31 - $49	96%
Senior Blue - Bc	$31	96%
Advantra-Mcr Advantage	$32	99%
Aetna	$32 - $74	99%
Centers Plan Hlty Living	$32	99%
Champva	$32	99%
Cigna	$32 - $74	99%
Ctrs Plan For Hlthy Livng	$32	99%
Geisinger Health Plan	$32	99%
Humana	$32	99%
Lifetime Benefits	$32	99%
Medicare (plans)	$32	99%
Mutual Of Omaha	$32	99%
Optimum Healthcare - Mcr	$32	99%
Todays Option - Amer Prog	$32	99%
Tricare	$32	99%
United Hc Mcr Solutions	$32	99%
UnitedHealthcare	$32	99%
Univera Senior Choice	$32	99%
Wellcare	$32	99%
Univera Healthcare	$36	111%
Private Pay	$63	194%
American Progressive Ins.	$74	228%
Commercial / Misc	$74	228%
Global Excel Mgt	$74	228%
Guardian Life Ins. Co.	$74	228%
Mvp Commercial	$74	228%
No Amer Meritian Health	$74	228%
No-Fault	$74	228%

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 $63.
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 Bertrand Chaffee 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.