CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: St Anthony Regional Hospital & Nursing Home

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $61
Cash Discount Price: $146
vs. Medicare Baseline: 1.88x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at St Anthony Regional Hospital & Nursing Home is $61. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $146. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.88x the Medicare baseline. Located in 311 South Clark Street, Carroll, IA.

Cash / Self-Pay

$146

Average discount available for prompt cash payment at this facility.

Insurance Median

$61

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: $146 (451%)

Insurance Median: $61 (188%)

Cash: $146 (451% of Medicare)

Ins. Median: $61 (188% 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
Aetna	$53 - $131	164%
Humana	$53 - $124	164%
Medica Mcr - All Plans	$53	164%
UnitedHealthcare	$53 - $118	164%
Va Ccn - All Plans	$53	164%
Wellpoint Mcr Adv	$53	164%
Ia Total Care Mcr	$54	167%
Ia Total Care Mcaid	$60	185%
Wellpoint Mcaid - All Other Plans	$60	185%
Molina Mcaid - All Plans	$61	188%
Ia Total Care Comm - All Other Plans	$68	210%
Wellmark Hmo	$121	373%
Wellmark Ppo-All Other Plans	$133	410%
Midlands Choice - All Plans	$137	423%

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 $146.
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 St Anthony Regional Hospital & Nursing Home 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.