CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Southern Hills Hospital and Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $100
Cash Discount Price: $373
vs. Medicare Baseline: 3.09x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Southern Hills Hospital and Medical Center is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $373. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.09x the Medicare baseline. Located in 9300 West Sunset Rd, Las Vegas, NV.

Cash / Self-Pay

$373

Average discount available for prompt cash payment at this facility.

Insurance Median

$100

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: $373 (1151%)

Insurance Median: $100 (309%)

Cash: $373 (1151% of Medicare)

Ins. Median: $100 (309% 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 309% of the Medicare baseline (a markup of 209%). 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
Aetna	$4 - $61	12%
Alignment Health Plan	$28 - $32	86%
Ambetter / Centene	$28 - $389	86%
Blue Cross Blue Shield	$28 - $32	86%
Hometown Health Mcr	$28 - $32	86%
Humana	$28 - $32	86%
Select Health	$28 - $427	86%
Triwest	$28 - $32	86%
Caremore	$29 - $33	90%
United	$29 - $404	90%
Community Care Health	$31	96%
Imperial Nv	$31 - $36	96%
Molina Healthcare	$31 - $32	96%
Sierra Hpn	$31	96%
Caresource	$32	99%
Health Net	$32	99%
Universal Healthcare	$34 - $39	105%
Corvel	$98	302%
Olympus Medsave Usa	$103 - $1,390	318%
Prominence Healthfirst	$108 - $556	333%
Cmn Global	$151 - $779	466%
Evernorth	$180 - $927	556%
Hometown Health Providers	$180 - $927	556%
Nv Health & Welfare Trust	$216 - $1,112	667%
Multiplan	$227 - $1,353	701%
First Health	$238 - $1,483	735%
Medcare International	$270 - $1,390	833%

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 $373.
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 Southern Hills Hospital and 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.