CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Tri Valley Health System

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $99
Cash Discount Price: $134
vs. Medicare Baseline: 3.06x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Tri Valley Health System is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $134. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.06x the Medicare baseline. Located in 1305 West Highway 6/34, Cambridge, NE.

Cash / Self-Pay

$134

Average discount available for prompt cash payment at this facility.

Insurance Median

$99

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: $134 (414%)

Insurance Median: $99 (306%)

Cash: $134 (414% of Medicare)

Ins. Median: $99 (306% 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 306% of the Medicare baseline (a markup of 206%). 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
Blue Cross Blue Shield	$55 - $164	170%
Humana	$55 - $76	170%
Medica Mcr Adv	$55 - $76	170%
Medica Prime Sol	$55 - $76	170%
Tricare	$55 - $76	170%
Wellcare Mcr Adv - All Plans	$55 - $76	170%
Great Plains Mcr Adv - All Plans	$58 - $80	179%
Healthy Blue Mcaid - All Plans	$60 - $83	185%
Molina Mcaid - All Plans	$60 - $83	185%
Nebraska Total Care-All Plans	$60 - $83	185%
UnitedHealthcare	$60 - $166	185%
Amerigroup Mcaid - All Plans	$61 - $85	188%
Medica Chi Aco - All Other Plans	$112 - $156	346%
Medica Chi Open Access	$112 - $156	346%
Medica Ifb Aco	$112 - $156	346%
Medica Ifb Open Access	$112 - $156	346%
Midlands Choice-All Plans	$112 - $156	346%
Aetna	$122 - $170	377%
Multiplan-All Plans	$122 - $170	377%

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 $134.
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 Tri Valley Health System 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.