CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Flushing Hospital Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $37
Cash Discount Price: $79
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Flushing Hospital Medical Center is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.14x the Medicare baseline. Located in 45Th Avenue and Parsons Boulevard, Flushing, NY.

Cash / Self-Pay

$79

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $79 (244%)

Insurance Median: $37 (114%)

Cash: $79 (244% of Medicare)

Ins. Median: $37 (114% 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
UnitedHealthcare	$23 - $202	71%
Healthfirst	$31	96%
Fidelis	$35 - $37	108%
Ghi	$35 - $37	108%
Aetna	$37	114%
Beacon Health Strategies	$37	114%
Centerlight Healthcare	$37	114%
Elderplan	$37	114%
Empire	$37 - $68	114%
Hip	$37 - $72	114%
Humana	$37 - $39	114%
Metroplus	$37 - $40	114%
Vns	$37	114%
Wellcare Of Ny	$38	117%
Senior Whole Health	$39	120%
Elderserve Health	$42	130%
Hamaspik Choice	$42	130%
Magnacare	$42	130%
Centers Plan For Healthy Living	$44	136%
1199 National Benefit Fund	$50	154%
Emblemhealth	$57	176%
Empire Blue Priority	$58	179%
Hotel Trades Council	$68 - $1,912	210%
Cigna	$264	815%

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 $79.
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 Flushing Hospital 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.