CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: South Lincoln Medical Center - Cah

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $109
Cash Discount Price: $103
vs. Medicare Baseline: 3.36x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at South Lincoln Medical Center - Cah is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.36x the Medicare baseline. Located in 711 Onyx Street, Kemmerer, WY.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $103 (318%)

Insurance Median: $109 (336%)

Cash: $103 (318% of Medicare)

Ins. Median: $109 (336% 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 336% of the Medicare baseline (a markup of 236%). 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
Aetna	$60 - $153	185%
Blue Cross Blue Shield	$60 - $135	185%
Humana	$60 - $84	185%
Altius Health Plans - All Plans	$103 - $145	318%
Cigna	$103 - $145	318%
Great West Healthcare - All Plans	$103 - $145	318%
Integrated Hp - All Plans	$103 - $145	318%
UnitedHealthcare	$103 - $145	318%
Winhealth Partners - All Plans	$103 - $145	318%
Ccn - All Plans	$109 - $153	336%
Geha - All Plans	$109 - $153	336%
Health Infonet/First Choice - All Plans	$109 - $153	336%
Three Rivers - All Plans	$109 - $153	336%

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 $103.
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 South Lincoln Medical Center - Cah 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.