CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Methodist Jennie Edmundson

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $66
Cash Discount Price: $33
vs. Medicare Baseline: 2.04x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Methodist Jennie Edmundson is $66. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $33. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.04x the Medicare baseline. Located in 933 East Pierce Street, Council Bluffs, IA.

Cash / Self-Pay

$33

Average discount available for prompt cash payment at this facility.

Insurance Median

$66

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: $33 (102%)

Insurance Median: $66 (204%)

Cash: $33 (102% of Medicare)

Ins. Median: $66 (204% 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 204% of the Medicare baseline (a markup of 104%). 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
Aetna	$30 - $104	93%
Blue Cross Blue Shield	$30 - $166	93%
Humana	$30	93%
Medica	$30 - $177	93%
Medicare (plans)	$30 - $78	93%
UnitedHealthcare	$30 - $322	93%
Ne Furniture Mart	$49 - $94	151%
Medica Choice	$54 - $208	167%
Elite Choice - Mje	$59 - $62	182%
Ambetter / Centene	$63 - $64	194%
Wellmark	$73 - $80	225%
Midlands Choice	$75 - $110	231%

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 $33.
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 Methodist Jennie Edmundson 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.