CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: South Peninsula Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $175
Cash Discount Price: $142
vs. Medicare Baseline: 5.40x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at South Peninsula Hospital is $175. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 5.40x the Medicare baseline. Located in 4300 Bartlett St, Homer, AK.

Cash / Self-Pay

$142

Average discount available for prompt cash payment at this facility.

Insurance Median

$175

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: $142 (438%)

Insurance Median: $175 (540%)

Cash: $142 (438% of Medicare)

Ins. Median: $175 (540% 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 540% of the Medicare baseline (a markup of 440%). 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
Liberty Healthshare - All Plans	$132	407%
Aetna	$160	494%
Geha - All Plans	$170	525%
Meritain - All Plans	$170	525%
Teamsters Emply - All Plans	$170	525%
Ufcw - All Plans	$170	525%
UnitedHealthcare	$174	537%
Blue Cross Blue Shield	$175	540%
Premera First - All Plans	$175	540%
Cigna	$179	552%
Great West - All Plans	$179	552%
Moda - All Plans	$179	552%
Multiplan Phcs - All Plans	$179	552%
Pmcs - All Plans	$179	552%
First Choice Health - All Plans	$185	571%

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 $142.
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 Peninsula 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.