CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Hammond Henry Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $105
Cash Discount Price: $126
vs. Medicare Baseline: 3.24x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Hammond Henry Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $126. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.24x the Medicare baseline. Located in 600 N College Avenue, Geneseo, IL.

Cash / Self-Pay

$126

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $126 (389%)

Insurance Median: $105 (324%)

Cash: $126 (389% of Medicare)

Ins. Median: $105 (324% 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 324% of the Medicare baseline (a markup of 224%). 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	$37	114%
Aetna	$41 - $105	127%
Health Alliance Mcare Adv	$41	127%
UnitedHealthcare	$41 - $133	127%
Wellmark Of Ia-All Plans	$70	216%
Blue Cross Blue Shield	$72 - $84	222%
Meridian Health Plan-All Plans	$72	222%
Quad City Community Hc-All Plans	$90	278%
Springfield Armory-All Plans	$91	281%
Ambetter / Centene	$98	302%
Health Alliance-All Other Plans	$105	324%
Multiplan Integrated Hp	$105	324%
Cigna	$108	333%
Multiplan Pponext	$112	346%
Osf Direct Access Network-All Plans	$112	346%
Multiplan-All Other Plans	$119	367%
Humana	$120	370%
Corvel-All Plans	$126	389%
Healthsmart Adult-All Other Plans	$126	389%
Healthsmart Pediatric	$126	389%
Hfn-All Plans	$126	389%
Multiplan Beech Street	$126	389%
Multiplan Phcs Adult	$126	389%
Multiplan Phcs Pediatric	$126	389%
Usa Mco-All Plans	$126	389%

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 $126.
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 Hammond Henry 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.