CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Saratoga Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $62
Cash Discount Price: $44
vs. Medicare Baseline: 1.91x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Saratoga Hospital is $62. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $44. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.91x the Medicare baseline. Located in 211 Church Street, Saratoga Springs, NY.

Cash / Self-Pay

$44

Average discount available for prompt cash payment at this facility.

Insurance Median

$62

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: $44 (136%)

Insurance Median: $62 (191%)

Cash: $44 (136% of Medicare)

Ins. Median: $62 (191% 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
Aetna	$15 - $206	46%
Cdphp	$41 - $97	127%
Emblem	$41 - $62	127%
Fidelis	$41 - $97	127%
Blue Cross Blue Shield	$42 - $80	130%
Mvp Essential Plan	$43 - $86	133%
Mvp Govt Programs	$43	133%
UnitedHealthcare	$43 - $79	133%
Empire Plan Nyship	$53 - $62	164%
Hamaspik	$55 - $101	170%
Mvp Commercial	$62 - $215	191%
Multiplan	$66 - $75	204%
Blue Shield	$77 - $256	238%
Magnacare	$79 - $84	244%

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 $44.
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 Saratoga Hospital 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.