CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Cass County Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $36
Cash Discount Price: $59
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Cass County Memorial Hospital is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.11x the Medicare baseline. Located in 1501 East Tenth Street, Atlantic, IA.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $59 (182%)

Insurance Median: $36 (111%)

Cash: $59 (182% of Medicare)

Ins. Median: $36 (111% 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.

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
Midlands Choice Medica Mcr	$17	52%
Triwest - All Plans	$34	105%
Aetna	$35 - $80	108%
Amerigroup Mcr Adv - All Other Plans	$35	108%
Medica Mcr Adv	$35	108%
Tricare	$35	108%
UnitedHealthcare	$35 - $76	108%
Va Ccn - All Plans	$35	108%
American Hlth Mcr Adv - All Plans	$36	111%
Iowa Total Care Mcaid	$36	111%
Iowa Total Care Mcr	$36	111%
Medicaid / KanCare	$36	111%
Molina Mcaid - All Plans	$36	111%
Wellmark Mcr Adv	$36	111%
Iowa Total Care Comm - All Other Plans	$39	120%
Midlands Choice New Bus	$55	170%
Medica Comm - All Other Plans	$74	228%
Midlands Choice Pho (Ppo) - All Other Plans	$76	235%
Wellmark Hmo	$78	241%
Multiplan - All Plans	$80	247%
Wellmark Ppo - All Other Plans	$85	262%

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 $59.
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 Cass County 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.