CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: St Claire Regional Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $132
Cash Discount Price: $152
vs. Medicare Baseline: 4.07x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at St Claire Regional Medical Center is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.07x the Medicare baseline. Located in 222 Medical Circle, Morehead, KY.

Cash / Self-Pay

$152

Average discount available for prompt cash payment at this facility.

Insurance Median

$132

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: $152 (469%)

Insurance Median: $132 (407%)

Cash: $152 (469% of Medicare)

Ins. Median: $132 (407% 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 407% of the Medicare baseline (a markup of 307%). 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	$15	46%
Beacon Bh - All Plans	$15	46%
Blue Cross Blue Shield	$30 - $146	93%
Caresource Mcr Adv	$30	93%
Humana	$30 - $142	93%
Caresource Just4Me - All Other Plans	$40	123%
Wellcare Mcaid	$47	145%
Medicaid / KanCare	$49 - $57	151%
Healthlink - All Plans	$141	435%
Wellcare Comm - All Other Plans	$173	534%
Ky Health Co-Op - All Plans	$264	815%

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 $152.
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 Claire Regional Medical Center 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.