CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: St Mary's Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $119
Cash Discount Price: $100
vs. Medicare Baseline: 3.67x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at St Mary's Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $100. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.67x the Medicare baseline. Located in 701 Lewiston St, Cottonwood, ID.

Cash / Self-Pay

$100

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $100 (309%)

Insurance Median: $119 (367%)

Cash: $100 (309% of Medicare)

Ins. Median: $119 (367% 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 367% of the Medicare baseline (a markup of 267%). 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	$86 - $143	265%
Aetna	$98 - $136	302%
Medicare (plans)	$98 - $120	302%
Regence Blue Shield Mcr	$98 - $120	302%
Tricare	$98 - $120	302%
UnitedHealthcare	$98 - $120	302%
Veterans Admin - All Plans	$98 - $120	302%
Nimiipuu Mcr Adv - Allplans	$99 - $121	306%
Idaho Phys Network - All Plans	$114 - $139	352%
Corizon Correctional - All Plans	$115 - $140	355%
Geha - All Plans	$116 - $142	358%
Multiplan - All Plans	$116 - $142	358%
First Choice- All Plans	$118 - $143	364%
Regence Blue Shield - All Other Plans	$120 - $146	370%

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 $100.
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 Mary's Hospital 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.