CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Montefiore New Rochelle Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $39
Cash Discount Price: $129
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Montefiore New Rochelle Hospital is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $129. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.11x the Medicare baseline. Located in 16 Guion Place, New Rochelle, NY.

Cash / Self-Pay

$129

Average discount available for prompt cash payment at this facility.

Insurance Median

$39

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $129 (368%)

Insurance Median: $39 (111%)

Cash: $129 (368% of Medicare)

Ins. Median: $39 (111% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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
Metroplus	$4 - $51	11%
Empire	$5 - $150	14%
Molina Healthcare Of Ny Affinity	$5 - $54	14%
Mvp	$5 - $176	14%
Healthfirst	$38 - $39	108%
Emblem	$39 - $249	111%
Fidelis	$39	111%
UnitedHealthcare	$39	111%
Villagecaremax	$39	111%
Vnsny Choice	$39	111%
Wellcare	$40	114%
Amidacare	$41	117%
Partners_Health_Plan	$41	117%
Hamaspik	$42	120%
Humana	$43	123%
Oscar	$127	362%
Cigna	$278 - $294	793%
Aetna	$300 - $336	855%
Northwell	$364	1038%

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 $129.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Montefiore New Rochelle Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
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.