CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Monroe County Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $85
Cash Discount Price: $100
vs. Medicare Baseline: 2.62x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Monroe County Hospital is $85. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.62x the Medicare baseline. Located in 6580 165Th Street, Albia, IA.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$85

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: $100 (309%)

Insurance Median: $85 (262%)

Cash: $100 (309% of Medicare)

Ins. Median: $85 (262% 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 262% of the Medicare baseline (a markup of 162%). 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
Mahp Mcare - All Plans	$68 - $72	210%
Tricare	$68 - $72	210%
UnitedHealthcare	$68 - $162	210%
Va Ccn - All Plans	$68 - $72	210%
Aetna	$69 - $161	213%
Amerigroup Mcare	$69 - $73	213%
Humana	$69 - $73	213%
Wellmark Mcare	$69 - $73	213%
Iowa Total Care Mcaid - All Plans	$81 - $85	250%
Molina Mcaid - All Plans	$82 - $87	253%
Amerigroup Mcaid - All Other Plans	$83 - $88	256%
Centivo - All Plans	$102 - $108	315%
Midlands Choice - All Plans	$113 - $120	349%
Preferred Hlth - All Plans	$122 - $128	377%
Geha - All Plans	$130 - $137	401%
Wellmark Hmo	$141	435%
Multiplan - All Plans	$146 - $154	451%
Wellmark Ppo - All Other Plans	$152	469%
Integrated Hp - All Plans	$157 - $166	485%

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 $100.
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 Monroe County 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.