CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Ellenville Regional Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $50
Cash Discount Price: $89
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Ellenville Regional Hospital is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.54x the Medicare baseline. Located in 10 Healthy Way, Ellenville, NY.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $89 (275%)

Insurance Median: $50 (154%)

Cash: $89 (275% of Medicare)

Ins. Median: $50 (154% 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	$18 - $161	56%
Galaxy Health	$38 - $77	117%
Emblemhealth	$39 - $95	120%
Hamaspik Choice	$39 - $48	120%
Mvp Health Care Of Ny	$41 - $187	127%
Wellcare	$41 - $65	127%
Cdphp	$44	136%
Blue Cross Blue Shield	$48	148%
Fidelis	$48	148%
Humana	$48	148%
Aetna	$55 - $115	170%
Local 1199Seiu	$55 - $115	170%
Oxford Health Plans	$161	497%

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 $89.
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 Ellenville Regional 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.