CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Community Hospital of Staunton

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $114
Cash Discount Price: $78
vs. Medicare Baseline: 3.52x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Community Hospital of Staunton is $114. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.52x the Medicare baseline. Located in 400 N Caldwell St, Staunton, IL.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$114

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: $78 (241%)

Insurance Median: $114 (352%)

Cash: $78 (241% of Medicare)

Ins. Median: $114 (352% 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 352% of the Medicare baseline (a markup of 252%). 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
Tricare	$30 - $51	93%
Medicare (plans)	$31 - $53	96%
Clear Spring Health Ma	$32 - $54	99%
Medicaid / KanCare	$63 - $176	194%
Self Pay	$67 - $88	207%
Cigna	$86 - $113	265%
Blue Cross Blue Shield	$101 - $176	312%
Healthlink	$101 - $150	312%
Health Alliance Commercial	$107 - $176	330%
Aetna	$109 - $176	336%
Multiplan/Phcs	$114 - $150	352%
Beech Street	$122 - $160	377%
UnitedHealthcare	$134 - $408	414%

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 $78.
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 Community Hospital of Staunton 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.