CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Bellevue Hospital Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $67
Cash Discount Price: $41
vs. Medicare Baseline: 2.07x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Bellevue Hospital Center is $67. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.07x the Medicare baseline. Located in 462 First Avenue, New York, NY.

Cash / Self-Pay

$41

Average discount available for prompt cash payment at this facility.

Insurance Median

$67

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: $41 (127%)

Insurance Median: $67 (207%)

Cash: $41 (127% of Medicare)

Ins. Median: $67 (207% 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 207% of the Medicare baseline (a markup of 107%). 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
Healthfirst	$18 - $144	56%
Aetna	$21 - $257	65%
Affinity	$32 - $144	99%
Blue Cross Blue Shield	$36 - $181	111%
Centerlight	$36 - $41	111%
Elderplan	$36 - $147	111%
Fidelis	$36 - $144	111%
Centers Plan For Healthy Living	$37	114%
Wellcare	$37 - $44	114%
Hamaspik	$38 - $41	117%
Oxford	$43 - $410	133%
Oscar	$45 - $614	139%
Metroplus	$46 - $144	142%
Amidacare	$64	198%
Carelon	$64 - $147	198%
Senior Whole Health	$64	198%
United	$64 - $504	198%
United Behavioral Health	$64 - $71	198%
Carelon (Amida Care)	$65	201%
Vnsny	$65 - $193	201%
Local 1199	$76 - $193	235%
Emblem	$96 - $319	296%
Magnacare	$170 - $320	525%
Multiplan	$181	559%
Villagecare Max	$193 - $209	596%
Cigna	$241	744%

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 $41.
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 Bellevue Hospital 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.