CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Nacogdoches Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $78
Cash Discount Price: $35
vs. Medicare Baseline: 2.41x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Nacogdoches Memorial Hospital is $78. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $35. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.41x the Medicare baseline. Located in 1204 Mound St, Nacogdoches, TX.

Cash / Self-Pay

$35

Average discount available for prompt cash payment at this facility.

Insurance Median

$78

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: $35 (108%)

Insurance Median: $78 (241%)

Cash: $35 (108% of Medicare)

Ins. Median: $78 (241% 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 241% of the Medicare baseline (a markup of 141%). 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	$32	99%
Wellmed	$32 - $121	99%
Healthspring	$33	102%
Molina	$33 - $121	102%
Hiet Benefit Plan	$34 - $121	105%
Blue Cross Blue Shield	$35 - $97	108%
Galaxy	$41 - $79	127%
Usa Health Network	$47 - $92	145%
Aetna	$50 - $97	154%
Healthsmart	$50 - $97	154%
Phcs	$50 - $97	154%
UnitedHealthcare	$134	414%

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 $35.
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 Nacogdoches Memorial 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.