CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Maimonides Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $29
Cash Discount Price: $182
vs. Medicare Baseline: 0.90x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Maimonides Medical Center is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $182. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.90x the Medicare baseline. Located in 4802 Tenth Avenue, Brooklyn, NY.

Cash / Self-Pay

$182

Average discount available for prompt cash payment at this facility.

Insurance Median

$29

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: $182 (562%)

Insurance Median: $29 (90%)

Cash: $182 (562% of Medicare)

Ins. Median: $29 (90% 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
Emblem Health - Hip	$7 - $48	22%
Blue Cross Blue Shield	$11 - $142	34%
Fidelis	$12 - $70	37%
Healthfirst	$12 - $51	37%
Aetna	$15 - $57	46%
UnitedHealthcare	$17 - $23	52%
Villagecare Maxx Fida	$26 - $37	80%
Oxford Health Plan	$27 - $37	83%
Oxford Liberty	$30	93%
Emblem Health - Ghi	$35 - $112	108%
United Community Plan	$41	127%
Metroplus	$44 - $55	136%
Local 1199	$50	154%
Centivo	$59	182%

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 $182.
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 Maimonides 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.