CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Saint Mary's Regional Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $37
Cash Discount Price: $32
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Saint Mary's Regional Medical Center is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.14x the Medicare baseline. Located in 235 W 6Th St, Reno, NV.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $32 (99%)

Insurance Median: $37 (114%)

Cash: $32 (99% of Medicare)

Ins. Median: $37 (114% 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
Access To Healthcare Network	$11	34%
Blue Cross Blue Shield	$31 - $32	96%
Health Plan Of Nevada	$31 - $32	96%
Medicaid / KanCare	$31	96%
Molina Healthcare Of Nv	$31 - $32	96%
Silver Summit	$31 - $57	96%
Aetna	$32 - $65	99%
Medicare (plans)	$32	99%
Saint Mary Health Plan	$32 - $37	99%
Sierra	$32	99%
Tricare	$32	99%
Triwest	$32	99%
Alignment	$33	102%
UnitedHealthcare	$33 - $143	102%
Pam	$37	114%
Veterans Evaluation Service Ves	$40	123%
Employer Direct	$45	139%
Home Town Test	$45	139%
Naphcare	$45	139%
Asserta Health	$49	151%
Imperial Insurance Company	$49 - $60	151%
Nevada Health Partners	$60	185%
6 Degrees	$65	201%
Occunet	$65 - $87	201%
Nv Preferred	$69 - $73	213%
Custom Ink	$70	216%

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 $32.
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 Saint Mary's Regional 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.