CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Shannon Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $126
Cash Discount Price: $86
vs. Medicare Baseline: 3.89x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Shannon Medical Center is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.89x the Medicare baseline. Located in 120 E Harris Ave., San Angelo, TX.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $86 (265%)

Insurance Median: $126 (389%)

Cash: $86 (265% of Medicare)

Ins. Median: $126 (389% 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 389% of the Medicare baseline (a markup of 289%). 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
City Of San Angelo	$23 - $30	71%
Care Improvement	$31	96%
Humana	$31 - $174	96%
Wellmed	$31	96%
Wellpoint	$42	130%
Scott & White	$50 - $150	154%
Insurance Management Services	$51	157%
Insurance Services Of Lubbock	$51	157%
Kempton Group	$62	191%
Pdh/Texas Trust	$62	191%
Ambetter / Centene	$67	207%
Web Tpa	$75 - $98	231%
90 Degree Benefits	$78	241%
Caprock	$78	241%
Aetna	$110 - $143	340%
Assurant Health	$110 - $143	340%
Blue Cross Blue Shield	$117 - $163	361%
Cigna	$120 - $156	370%
First Health	$124 - $163	383%
UnitedHealthcare	$129 - $169	398%
Healthsmart	$148 - $193	457%

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 $86.
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 Shannon 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.