CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Valley Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $95
Cash Discount Price: $89
vs. Medicare Baseline: 2.93x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Valley Medical Center is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.93x the Medicare baseline. Located in 400 S 43Rd St, Renton, WA.

Cash / Self-Pay

$89

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $89 (275%)

Insurance Median: $95 (293%)

Cash: $89 (275% of Medicare)

Ins. Median: $95 (293% 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 293% of the Medicare baseline (a markup of 193%). 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
UnitedHealthcare	$36 - $95	111%
Regence Blue Shield [170100]	$46 - $49	142%
Regence Uniform [130111]	$46	142%
Blue Cross Blue Shield	$49	151%
Regence Hma [170105]	$49	151%
Regence Hma1 [170102]	$49	151%
Bh United [180100]	$51	157%
Aetna	$86	265%
Benefit Md [150113]	$95	293%
Carpenters Trust [150122]	$95	293%
Cement Masons And Plasterers [150127]	$95	293%
Coresource [150109]	$95	293%
Employee Benefit Management Services [150108]	$95	293%
Fc Moda Health [150139]	$95	293%
First Choice Health Administrators [150110]	$95	293%
First Choice Health Comp [150112]	$95	293%
First Choice [150134]	$95	293%
Health Net [150111]	$95	293%
Here [150114]	$95	293%
Hotel Employees Health Trust [150115]	$95	293%
International Longshore & Warehouse Union [150116]	$95	293%
Kitsap Physician Services [150118]	$95	293%
Loomis Benefits West [150119]	$95	293%
Mega [150120]	$95	293%
Midwest [150121]	$95	293%
Nw Administrators [150123]	$95	293%
Operating Engineers [150125]	$95	293%
Painters Trust [150126]	$95	293%
Puget Sound Electric [150131]	$95	293%
Seattle Plumb And Pipe [150132]	$95	293%
Trusteed Plan [150101]	$95	293%
United Employee Benefit Trust [150137]	$95	293%
Washington Bakers Trust [150102]	$95	293%
Washington Employers Trust [150103]	$95	293%
Washington State Health Ins Pool [150104]	$95	293%
Welfare Pension Administration Services [150105]	$95	293%
Zenith Admin [150106]	$95	293%
Zzjohn Alden [150117]	$95	293%
Zzprincipal Financial Group [150128]	$95	293%
Zzprovidence [150129]	$95	293%

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 $89.
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 Valley 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.