CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: PAM Rehabilitation Hospital of Allen

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $84
Cash Discount Price: $114
vs. Medicare Baseline: 2.59x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at PAM Rehabilitation Hospital of Allen is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.59x the Medicare baseline. Located in 1001 Raintree Circle, Allen, TX.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$84

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: $114 (352%)

Insurance Median: $84 (259%)

Cash: $114 (352% of Medicare)

Ins. Median: $84 (259% 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 259% of the Medicare baseline (a markup of 159%). 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	$22 - $23	68%
Southwestern Accountable Care	$25	77%
Curative	$45 - $46	139%
Imperial Insurance Of Texas	$45 - $46	139%
Ninety Degree Benefits	$56 - $58	173%
Healthcare Highways	$61 - $64	188%
Cigna	$70 - $115	216%
America'S Choice Provider Network	$78 - $81	241%
Provider Network Of America	$84 - $87	259%
Quik Trip	$84 - $87	259%
Usa Managed Care Organization	$84 - $87	259%
Velocity Provider Ppo Network	$84 - $87	259%
Multiplan/Phcs	$89 - $93	275%
Ambetter / Centene	$95	293%
Prime Health Services	$95 - $98	293%
Medincrease	$100 - $104	309%

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 $114.
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 PAM Rehabilitation Hospital of Allen 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.