CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: South Brooklyn Health

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $145
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.48x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at South Brooklyn Health is $145. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.48x the Medicare baseline. Located in 2601 Ocean Parkway, Brooklyn, NY.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$145

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%)

Insurance Median: $145 (448%)

Ins. Median: $145 (448% 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 448% of the Medicare baseline (a markup of 348%). 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
Aetna	$21 - $257	65%
Healthfirst	$29 - $149	90%
Wellcare	$40	123%
Fidelis	$53 - $149	164%
Amidacare	$66	204%
Blue Cross Blue Shield	$66 - $181	204%
Carelon	$66 - $147	204%
Metroplus	$66 - $149	204%
Senior Whole Health	$66	204%
United	$66 - $504	204%
United Behavioral Health	$66 - $73	204%
Affinity	$68 - $149	210%
Carelon (Amida Care)	$68	210%
Vnsny	$68 - $193	210%
Emblem	$99 - $319	306%
Centerlight	$113	349%
Elderplan	$147	454%
Magnacare	$170 - $320	525%
Multiplan	$181	559%
Local 1199	$193	596%
Villagecare Max	$193 - $209	596%
Oxford	$236 - $410	728%
Cigna	$241	744%
Oscar	$251 - $614	775%

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 $X.
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 South Brooklyn Health 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.