CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Banner - University Medical Center Phoenix

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $91
Cash Discount Price: $25
vs. Medicare Baseline: 2.81x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Banner - University Medical Center Phoenix is $91. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $25. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.81x the Medicare baseline. Located in 1111 East McDowell Road, Phoenix, AZ.

Cash / Self-Pay

$25

Average discount available for prompt cash payment at this facility.

Insurance Median

$91

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: $25 (77%)

Insurance Median: $91 (281%)

Cash: $25 (77% of Medicare)

Ins. Median: $91 (281% 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 281% of the Medicare baseline (a markup of 181%). 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	$36 - $103	111%
Arizona Physicians Ipa	$40	123%
Health Choice Arizona, Inc.	$40 - $89	123%
Health Net	$40 - $96	123%
Mercy Care	$40	123%
Blue Cross Blue Shield	$49 - $167	151%
Arizona Priority Care	$71	219%
National Healthcare Solutions Inc (Nhsi) And Vip Universal Medical Insurance Group (Vumi)	$80	247%
Plotkin Health	$80	247%
Oscar Health Plan	$89	275%
Quiktrip Corporation	$96	296%
Arizona Medical Network	$125	386%
Provider Network Of America	$134	414%
Cigna	$203 - $225	627%
UnitedHealthcare	$241 - $265	744%

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 $25.
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 Banner - University Medical Center Phoenix 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.