CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: HSHS St Elizabeth's Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $109
Cash Discount Price: $99
vs. Medicare Baseline: 3.36x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at HSHS St Elizabeth's Hospital is $109. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.36x the Medicare baseline. Located in One St Elizabeth Boulevard, O Fallon, IL.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$109

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: $99 (306%)

Insurance Median: $109 (336%)

Cash: $99 (306% of Medicare)

Ins. Median: $109 (336% 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 336% of the Medicare baseline (a markup of 236%). 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
Molina Healthcare	$28 - $32	86%
Meridian Health Plan	$29	90%
Aetna	$31 - $96	96%
Blue Cross Blue Shield	$31 - $137	96%
Clear Spring Health Of Illinois	$31	96%
Health Alliance Medical Plans	$31 - $116	96%
Health Partners	$31	96%
Humana	$31	96%
Sae Hospice	$31	96%
UnitedHealthcare	$31 - $137	96%
Amish Community	$38	117%
Celtic Insurance Company	$66	204%
Naphcare	$69	213%
Claim Doc	$77	238%
Hopetrust	$77	238%
Wellfirst	$88	272%
First Health	$102	315%
Cigna	$108 - $137	333%
Healthlink	$109 - $137	336%
Caterpillar, Inc.	$110	340%
Consociate Group	$121	373%
Choicecare	$123	380%
Healthcare Finest Network (Hfn)	$123	380%
Multiplan/Phcs	$123	380%
Provider Network Of America	$123	380%
City Of Springfield	$137	423%
Current Health Solutions	$137	423%
Healthscope	$137	423%
Illinois Breast And Cervical Cancer Program	$137	423%
Interplan	$137	423%
Live360	$137	423%
Wexford	$137	423%

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 $99.
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 HSHS St Elizabeth's 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.