CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Snoqualmie Valley Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $103
Cash Discount Price: $130
vs. Medicare Baseline: 3.18x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Snoqualmie Valley Hospital is $103. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $130. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.18x the Medicare baseline. Located in 9801 Frontier Ave Se, Snoqualmie, WA.

Cash / Self-Pay

$130

Average discount available for prompt cash payment at this facility.

Insurance Median

$103

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: $130 (401%)

Insurance Median: $103 (318%)

Cash: $130 (401% of Medicare)

Ins. Median: $103 (318% 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 318% of the Medicare baseline (a markup of 218%). 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	$93 - $132	287%
Amerigroup Wellpoint	$93 - $112	287%
Community Health Plan Of Wa	$93 - $98	287%
Medicare (plans)	$93 - $96	287%
Molina Healthcare Of Washington Mcr Adv	$93 - $96	287%
Blue Shield Of Wa Regence Mcr Adv	$94 - $97	290%
Humana	$94 - $97	290%
Molina Healthcare Of Washington	$95 - $98	293%
UnitedHealthcare	$95 - $209	293%
Washington Coordinated Care	$95 - $114	293%
Community Health Plan Of Wa Mcd Rep	$103 - $106	318%
Medicaid / KanCare	$103 - $106	318%
Molina Healthcare Of Washington Mcd Rep	$111 - $114	343%
Blue Cross Blue Shield	$132 - $136	407%
Blue Shield Of Wa Regence	$132 - $136	407%
Kaiser Foundation Health Plan Of The Northwest	$139 - $143	429%
First Choice Health Network	$154 - $159	475%
Cigna	$177 - $182	546%

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 $130.
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 Snoqualmie Valley 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.