CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: St Vincent's Birmingham

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $99
Cash Discount Price: Unavailable
vs. Medicare Baseline: 3.06x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at St Vincent's Birmingham is $99. 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 3.06x the Medicare baseline. Located in 810 St Vincent's Drive, Birmingham, AL.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$99

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: $99 (306%)

Ins. Median: $99 (306% 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 306% of the Medicare baseline (a markup of 206%). 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	$7 - $80	22%
Ambetter / Centene	$30	93%
Viva	$32 - $95	99%
Humana	$34 - $100	105%
Construction Claims Management	$39 - $115	120%
Corvel	$39 - $115	120%
Alamed	$41 - $122	127%
Comp One	$41 - $122	127%
Multiplan	$43 - $127	133%
Pnoa	$43 - $127	133%
Prime Health Services	$45 - $134	139%
Novanet	$46 - $135	142%
Cigna	$112	346%
UnitedHealthcare	$250	772%

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 St Vincent's Birmingham 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.