CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Kootenai Health

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $40
Cash Discount Price: $80
vs. Medicare Baseline: 1.23x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Kootenai Health is $40. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $80. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.23x the Medicare baseline. Located in 2003 Kootenai Health Way, Coeur D'Alene, ID.

Cash / Self-Pay

$80

Average discount available for prompt cash payment at this facility.

Insurance Median

$40

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: $80 (247%)

Insurance Median: $40 (123%)

Cash: $80 (247% of Medicare)

Ins. Median: $40 (123% 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
Coordinated Care Of Washington	$20	62%
Molina Healthcare Of Idaho	$20 - $40	62%
Molina Healthcare Of Washington	$20	62%
Magellan	$30	93%
Wellpoint	$30	93%
Aetna	$31 - $89	96%
Blue Cross Blue Shield	$31 - $101	96%
Humana	$31	96%
Pacificsource	$31 - $88	96%
Premera	$31 - $66	96%
Regence Blue Shield Of Idaho	$31 - $33	96%
UnitedHealthcare	$31 - $96	96%
Group Health/Kaiser	$46 - $111	142%
Mountain Health Co-Op	$83	256%
Cigna	$88 - $89	272%
First Choice Health (Ameriben)	$91 - $93	281%
Interwest Health	$91	281%

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 $80.
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 Kootenai Health 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.