CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Artesia General Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $153
Cash Discount Price: $115
vs. Medicare Baseline: 4.72x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Artesia General Hospital is $153. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $115. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.72x the Medicare baseline. Located in 702 N 13Th Street, Artesia, NM.

Cash / Self-Pay

$115

Average discount available for prompt cash payment at this facility.

Insurance Median

$153

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: $115 (355%)

Insurance Median: $153 (472%)

Cash: $115 (355% of Medicare)

Ins. Median: $153 (472% 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 472% of the Medicare baseline (a markup of 372%). 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
Humana	$43 - $113	133%
Zelis	$43 - $218	133%
Blue Cross Blue Shield	$55 - $262	170%
Molina Healthcare Of New Mexico	$56	173%
Presbyterian Health Plan	$56 - $64	173%
UnitedHealthcare	$56 - $371	173%
First Health	$61 - $392	188%
New Mexico Health Connections	$99 - $262	306%
Geha	$116 - $349	358%
Omni Networks	$116 - $305	358%
Three Rivers Provider Network	$124 - $327	383%
Cigna	$140 - $392	432%
Triwest	$145 - $384	448%
Galaxy Health	$148 - $392	457%
One Health Plan	$148 - $392	457%
Multiplan	$150 - $397	463%
United Payors & United Providers	$153 - $405	472%
Providence Risk & Insurance Services	$157 - $414	485%

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 $115.
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 Artesia General 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.