CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: St Francis Regional Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $92
Cash Discount Price: $81
vs. Medicare Baseline: 2.84x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at St Francis Regional Medical Center is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $81. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.84x the Medicare baseline. Located in 1455 St Francis Avenue, Shakopee, MN.

Cash / Self-Pay

$81

Average discount available for prompt cash payment at this facility.

Insurance Median

$92

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: $81 (250%)

Insurance Median: $92 (284%)

Cash: $81 (250% of Medicare)

Ins. Median: $92 (284% 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 284% of the Medicare baseline (a markup of 184%). 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
Medicaid / KanCare	$26	80%
Health Partners	$27 - $123	83%
South Country Health Alliance	$27	83%
Ucare Pmap (A B C D E G N O S U R H)	$29	90%
Aetna	$31 - $86	96%
Medicare (plans)	$32	99%
Medica	$33 - $253	102%
Blue Cross Blue Shield	$34 - $103	105%
Scha Msho (S)	$35	108%
Americas Ppo (Araz)(B D N O R S V)	$112	346%
Americas Ppo (Araz) (B D N H O R S)	$122	377%
First Health (A C E G H U B D N O R S)	$122	377%
Cigna	$131 - $134	404%
All Other Contracted Care (A B C D E G H N O R S U)	$146	451%
Medica Health System	$160 - $266	494%
Medica Mhps	$253	781%
UnitedHealthcare	$311	960%

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 $81.
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 Francis 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.