CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: St Luke's Nampa Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $64
Cash Discount Price: $80
vs. Medicare Baseline: 1.98x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at St Luke's Nampa Medical Center is $64. 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 1.98x the Medicare baseline. Located in 9850 West St Lukes Drive, Nampa, ID.

Cash / Self-Pay

$80

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: $80 (247%)

Insurance Median: $64 (198%)

Cash: $80 (247% 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
UnitedHealthcare	$32 - $66	99%
Blue Cross Blue Shield	$51 - $82	157%
Commercial [1028]	$51 - $82	157%
Mountain Health Co-Op [1067]	$51 - $52	157%
Pacificsource [1020]	$51 - $60	157%
Select Health [1063]	$51 - $82	157%
Slplan Tap Mc St Lukes Health Plan [1641000001]	$51 - $82	157%
St Lukes Health Plan [1046]	$51 - $82	157%
Aetna	$64 - $72	198%
Cigna	$64	198%
Providence [1022]	$64	198%
Webtpa [1071]	$64 - $68	198%
First Health [1064]	$66 - $68	204%
Geha [1065]	$66	204%
United Medical Resources [1051]	$66	204%
Moda [1055]	$70	216%
Regence [1005]	$74 - $78	228%
Blue Shield Alt [100401]	$78	241%
Regence Out Of State [1004]	$78	241%

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 St Luke's Nampa Medical Center 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.