CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Yoakum County Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $64
Cash Discount Price: $85
vs. Medicare Baseline: 1.98x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Yoakum County Hospital is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.98x the Medicare baseline. Located in 412 Mustang Avenue, Denver City, TX.

Cash / Self-Pay

$85

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $85 (262%)

Insurance Median: $64 (198%)

Cash: $85 (262% of Medicare)

Ins. Median: $64 (198% 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
90 Degree Benefits	$33	102%
Firstcare	$37 - $45	114%
Multiplan	$37 - $87	114%
Aetna	$38 - $84	117%
Humana	$38 - $64	117%
Insurance Services Of Lubbock	$38 - $64	117%
UnitedHealthcare	$38 - $79	117%
Dars	$41 - $69	127%
Healthsmart	$49 - $84	151%
Phcs	$49 - $84	151%
Capstar	$52 - $89	160%
Provider Network	$57 - $97	176%
Blue Cross Blue Shield	$58 - $99	179%
Cigna	$58 - $70	179%

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 $85.
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 Yoakum County 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.