CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Howard County Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $194
Cash Discount Price: $284
vs. Medicare Baseline: 5.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Howard County Medical Center is $194. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $284. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 5.99x the Medicare baseline. Located in P O Box 406, 1113 Sherman St, St Paul, NE.

Cash / Self-Pay

$284

Average discount available for prompt cash payment at this facility.

Insurance Median

$194

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: $284 (877%)

Insurance Median: $194 (599%)

Cash: $284 (877% of Medicare)

Ins. Median: $194 (599% 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 599% of the Medicare baseline (a markup of 499%). 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
Humana	$26	80%
Aetna	$30 - $430	93%
Blue Cross Blue Shield	$30 - $430	93%
Great Plains	$30 - $258	93%
Medica Chi	$30 - $258	93%
Medica Standard Premier	$30	93%
Tricare	$30 - $340	93%
UnitedHealthcare	$30 - $435	93%
Medica Elevate	$31 - $60	96%
Nebraska Total Care - Wellcare	$31	96%
Molina Healthcare	$32 - $226	99%
Ambetter / Centene	$46	142%
Oscar Health	$53	164%
Nebraska Total Care	$56 - $226	173%
Beshp	$61	188%
Midland'S Choice	$63	194%
Medica Chi Aco	$103 - $412	318%
Medica Choice National	$103 - $412	318%
Medica Ifb Aco	$108 - $435	333%
Medica Ifb Open Access	$108 - $435	333%

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 $284.
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 Howard County 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.