CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: PAM Health Rehabilitation Hospital of El Paso

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $41
Cash Discount Price: $73
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at PAM Health Rehabilitation Hospital of El Paso is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.27x the Medicare baseline. Located in 1600 E Cliff Dr, El Paso, TX.

Cash / Self-Pay

$73

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $73 (225%)

Insurance Median: $41 (127%)

Cash: $73 (225% of Medicare)

Ins. Median: $41 (127% 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.

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	$14 - $22	43%
Blue Cross Blue Shield	$15 - $38	46%
Turquoise Care	$15	46%
Alignment Health Plan	$22	68%
El Paso First Health Plan	$22 - $27	68%
Wellpoint (Amerigroup)	$27 - $34	83%
Curative	$29	90%
Presbyterian Network	$30	93%
Ninety Degree Benefits	$36	111%
Multiplan/Phcs	$44	136%
Americas Choice	$51	157%
Quik Trip	$54	167%
Usa Managed Care Organization	$54	167%
Velocity	$54	167%
Prime Health Services	$62	191%
Cigna	$70 - $115	216%
Molina	$110	340%

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 $73.
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 Health Rehabilitation Hospital of El Paso 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.