CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Holy Family Memorial

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $96
Cash Discount Price: $73
vs. Medicare Baseline: 2.96x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Holy Family Memorial is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.96x the Medicare baseline. Located in 2300 Western Ave, Manitowoc, WI.

Cash / Self-Pay

$73

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $73 (225%)

Insurance Median: $96 (296%)

Cash: $73 (225% of Medicare)

Ins. Median: $96 (296% 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 296% of the Medicare baseline (a markup of 196%). 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	$31 - $248	96%
Community Care Incorporated	$31	96%
Health Partners	$31 - $86	96%
Humana	$31	96%
Icare	$31	96%
Molina	$31 - $34	96%
Network Health Plan	$31 - $263	96%
Security Health Plan	$31 - $106	96%
UnitedHealthcare	$31 - $370	96%
Allwell	$32	99%
Medical College Of Wisconsin	$44	136%
Centivo	$53 - $61	164%
Dean Health Plan	$66	204%
Health Payment Systems	$75	231%
Sheboygan Employers Health Network	$80	247%
Chorus Community Health Plan	$86	265%
Trilogy	$88	272%
Cigna	$96	296%
Wps Health Plan	$98	302%
Aspirus	$106	327%
Healtheos	$106	327%
Multiplan/Private Healthcare Systems	$106	327%
Preferred One	$106	327%
Healthsmart	$110	340%
First Health Network	$117	361%

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 $73.
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 Holy Family Memorial 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.