CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Palos Community Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $188
Cash Discount Price: $188
vs. Medicare Baseline: 5.80x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Palos Community Hospital is $188. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $188. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 5.80x the Medicare baseline. Located in 12251 South 80Th Avenue, Palos Heights, IL.

Cash / Self-Pay

$188

Average discount available for prompt cash payment at this facility.

Insurance Median

$188

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: $188 (580%)

Insurance Median: $188 (580%)

Cash: $188 (580% of Medicare)

Ins. Median: $188 (580% 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 580% of the Medicare baseline (a markup of 480%). 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
Blue Cross Blue Shield	$43 - $269	133%
Cigna	$50 - $269	154%
Aetna	$58 - $269	179%
Carelon Behavioral Health [159]	$134	414%
Healthlink [125]	$134 - $269	414%
First Health Plan [6034]	$153 - $202	472%
Magellan Behavioral Hlth [136]	$161	497%
The Alliance [1703]	$173	534%
Multiplan/Phcs [142]	$188 - $269	580%
Compsych [112]	$202	623%
Beechstreet [176]	$215	664%
Health'S Finest Network [126]	$229	707%
Galaxy Health Network [220]	$269	830%
Global Excel [1712]	$269	830%
Health Alliance [181]	$269	830%
UnitedHealthcare	$269	830%

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 $188.
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 Palos Community 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.