CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Holy Cross Hospital - Salt Lake

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $97
Cash Discount Price: $74
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Holy Cross Hospital - Salt Lake is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.99x the Medicare baseline. Located in 1050 East South Temple, Salt Lake City, UT.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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: $74 (228%)

Insurance Median: $97 (299%)

Cash: $74 (228% of Medicare)

Ins. Median: $97 (299% 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 299% of the Medicare baseline (a markup of 199%). 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	$29 - $111	90%
Denver Health	$33	102%
Health Choice	$33	102%
Humana	$33	102%
Medicaid / KanCare	$33	102%
Medicare (plans)	$33	102%
Rocky Mountain Health Plan	$33	102%
Uuhp	$33 - $100	102%
Employer Direct Healthcare	$41	127%
Motivhealth	$43	133%
Molina	$69 - $79	213%
Centura Employee Plan	$72	222%
Pehp	$79 - $184	244%
Aetna	$81 - $156	250%
Wise	$96 - $98	296%
Deseret Mutual Benefit Administrators	$113	349%
Select Health	$122	377%
Multiplan	$127 - $168	392%
Cigna	$147 - $302	454%
Emi Health	$184	568%
UnitedHealthcare	$316	975%

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 $74.
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 Holy Cross Hospital - Salt Lake 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.