CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: St Louis Childrens Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $71
Cash Discount Price: $60
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at St Louis Childrens Hospital is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $60. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.19x the Medicare baseline. Located in One Childrens Place, Saint Louis, MO.

Cash / Self-Pay

$60

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

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: $60 (185%)

Insurance Median: $71 (219%)

Cash: $60 (185% of Medicare)

Ins. Median: $71 (219% 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 219% of the Medicare baseline (a markup of 119%). 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	$31 - $79	96%
Blue Cross Blue Shield	$31 - $85	96%
Essence Healthcare [221]	$31	96%
Humana	$31 - $74	96%
UnitedHealthcare	$31 - $74	96%
Cox Health [757]	$33	102%
Medica [662]	$33	102%
Healthlink [225]	$48 - $76	148%
Cigna	$49 - $54	151%
Apwu Health Plan [216]	$54	167%
Consociate [478]	$54	167%
Nalc Health Benefit Plan [242]	$54	167%
Priority Health [648]	$54	167%
Sarah Bush Lincoln [636]	$54	167%
Cox Health Systems Insurance Company [220]	$55 - $74	170%
Allied Benefits [498]	$58 - $79	179%
Hope Trust [806]	$58	179%
Med-Pay [480]	$65 - $75	201%
Unicare [568]	$65 - $76	201%
Health Alliance [224]	$70	216%
Healthscope Benefits [258]	$71 - $80	219%
First Health Commercial [734]	$74	228%
Beechstreet [551]	$75	231%
Detego Health [868]	$75	231%
Health Systems Inc [620]	$75	231%
Healthcare Sol Mercy [609]	$75	231%
Multiplan Commercial [737]	$75	231%
Multiplan [240]	$75	231%
Phcs [244]	$75 - $80	231%
Preferred Health Professionals [561]	$76	235%
Coresource [497]	$79	244%
Fmh Benefit Service Inc [222]	$79	244%
Mail Handlers [495]	$79	244%
Medica [661]	$80	247%
Hfn [563]	$85	262%

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 $60.
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 Louis Childrens 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.