CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Margaretville Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $158
Cash Discount Price: $205
vs. Medicare Baseline: 4.88x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Margaretville Memorial Hospital is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $205. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.88x the Medicare baseline. Located in 42084 State Highway 28, Margaretville, NY.

Cash / Self-Pay

$205

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

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: $205 (633%)

Insurance Median: $158 (488%)

Cash: $205 (633% of Medicare)

Ins. Median: $158 (488% 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 488% of the Medicare baseline (a markup of 388%). 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
Hamaspik (McR)	$90	278%
Blue Cross Blue Shield	$90 - $210	278%
Aetna	$90 - $210	278%
Mvp Gold (McR)	$90	278%
UnitedHealthcare	$90 - $176	278%
Medicare (plans)	$90 - $135	278%
Affinity By Molina McR	$95	293%
Cdphp	$99	306%
Mvp	$136	420%
Magnacare Standard	$144	444%
Oxford	$147 - $165	454%
Todays Options	$149	460%
Emblem Select Care (Exchange)	$154	475%
Emblem Ghi/Hip Ppo/Cbp	$156	481%
Self-Pay	$157	485%
Oxford Exchange	$158	488%
Multiplan	$168	519%
Emblem Ghi/Hip Hmo/Epo/Pos	$181	559%
First Health	$184	568%
Emblem	$230 - $270	710%
Mvp Exchange	$238	735%
Mvp Hmo/Ppo	$280	864%
Magnacare	$390	1204%
Magnacare Preferred	$413	1275%

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 $205.
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 Margaretville Memorial 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.