CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: St Nicholas Hospital

Billing Code: 97535 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$61

about 1.9× the $32 Medicare rate · typically $31–$104

modeled estimate · not a bill or quote

What this hospital charges insurers

$31

Below the fair price — a good deal

about $30 under the fair price · 1.0× Medicare

Medicare pays $32 Fair price $61 This hospital $31 Cash price $89 Hospital's list price $135

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

A typical price — 0 charge more and 5 charge less, among the 9 WI hospitals compared.

Cheapest $23 Priciest $31

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Occupational therapy (self-care training) is about $61 (about 1.9× the $32 Medicare rate). St Nicholas Hospital charges insurers about $31, or about $89 in cash — below the fair price — a good deal. Located in Sheboygan, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$31 - $135	96%
Blue Cross Blue Shieldmajor	$21 - $135	65%
Aetnamajor	$31 - $135	96%
Cignamajor	$94	290%
Humanamajor	$31 - $115	96%
Health Net	$135	417%
Medica	$31	96%
Meridian	$21	65%
Molina	$22 - $68	68%
Security Health Plan	$31 - $86	96%
+ 15 smaller / regional plans	$14 - $135

Government programs also on file: Medicare, Medicaid.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 89), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97535.

Insurance Before you use insurance

Call your insurance company to confirm St Nicholas Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 97535.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at St Nicholas Hospital

Compare: Occupational therapy (self-care training) at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.