CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Iowa Specialty Hospital - Clarion

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $76
Cash Discount Price: $57
vs. Medicare Baseline: 2.35x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Iowa Specialty Hospital - Clarion is $76. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $57. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.35x the Medicare baseline. Located in 1316 South Main Street, Clarion, IA.

Cash / Self-Pay

$57

Average discount available for prompt cash payment at this facility.

Insurance Median

$76

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: $57 (176%)

Insurance Median: $76 (235%)

Cash: $57 (176% of Medicare)

Ins. Median: $76 (235% 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 235% of the Medicare baseline (a markup of 135%). 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
Tricare	$28 - $31	86%
Triwest Va - All Plans	$28 - $31	86%
Healthscope Stellar-All Plans	$48 - $53	148%
Auxiant Clarion Schools-All Plans	$58 - $66	179%
Health Partners Prestage	$68 - $76	210%
Health Partners Ish-All Other Plans	$72 - $81	222%
Aetna	$76 - $86	235%
Wellmark Hmo	$78	241%
Wellmark Ppo - All Other Plans	$85	262%
UnitedHealthcare	$86 - $96	265%
Cigna	$87 - $98	269%
Midlands Choice-All Plans	$87 - $98	269%

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 $57.
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 Iowa Specialty Hospital - Clarion 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.