CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Harrison County Community Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $52
Cash Discount Price: $59
vs. Medicare Baseline: 1.60x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Harrison County Community Hospital is $52. 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 1.60x the Medicare baseline. Located in 2600 Miller Street, Bethany, MO.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$52

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: $52 (160%)

Cash: $59 (182% of Medicare)

Ins. Median: $52 (160% 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
Multiplan	$29 - $72	90%
Care Improvement Plus	$30 - $52	93%
Cigna	$30 - $72	93%
Provider Partners Health Plans	$30 - $56	93%
Blue Cross Blue Shield	$32 - $79	99%
Allwell	$34 - $52	105%
Ambetter / Centene	$34 - $52	105%
Blue Advantage Plus	$34 - $52	105%
Humana	$34 - $81	105%
UnitedHealthcare	$34 - $76	105%
Aetna	$41 - $79	127%
Healthy Blue	$41 - $42	127%
Home State	$41 - $42	127%
6 Degrees Health	$43 - $72	133%
Wellmark	$72	222%

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 Harrison County Community 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.