CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: University of Alabama Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $120
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.70x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at University of Alabama Hospital is $120. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.70x the Medicare baseline. Located in 619 South 19Th Street, Birmingham, AL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$120

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%)

Insurance Median: $120 (370%)

Ins. Median: $120 (370% 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 370% of the Medicare baseline (a markup of 270%). 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
Viva	$16	49%
Triwest	$31	96%
University Of Alabama	$63 - $86	194%
UnitedHealthcare	$69 - $154	213%
Aetna	$77 - $106	238%
Coventry	$82 - $140	253%
North Alabama Managed Care	$82 - $112	253%
Cigna	$84 - $132	259%
Comp One	$91 - $125	281%
Alamed	$94 - $130	290%
Construction Claims Management	$94 - $129	290%
Corvel	$101 - $138	312%
Evolutions	$101 - $156	312%
Healthcare Alliance	$101 - $138	312%
Novanet	$101 - $156	312%
Prime Health Services	$101 - $156	312%
Select Value Care	$101 - $138	312%
Starcare	$101 - $138	312%
Tethys	$101 - $138	312%
Multiplan	$103 - $142	318%
Department Of Labor	$107 - $147	330%
Geha	$107 - $147	330%
Gulf Health Plans	$107 - $147	330%
Heritage Summit Health	$107 - $147	330%
Humana	$107 - $147	330%
Mississippi Physicians	$107 - $147	330%
Phifer	$107 - $147	330%
Preferred Health Partnership	$107 - $147	330%
Southern Nuclear	$107 - $147	330%
Vantage Health Plan	$107 - $147	330%
Galaxy Health Network	$113 - $156	349%
National Provider Network	$113 - $156	349%
North Mississippi Health Link	$113 - $156	349%

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 $X.
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 University of Alabama 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.