CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Wabash General Hospital 1

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $158
Cash Discount Price: $211
vs. Medicare Baseline: 4.88x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Wabash General Hospital 1 is $158. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $211. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.88x the Medicare baseline. Located in 1418 College Drive, Mount Carmel, IL.

Cash / Self-Pay

$211

Average discount available for prompt cash payment at this facility.

Insurance Median

$158

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: $211 (651%)

Insurance Median: $158 (488%)

Cash: $211 (651% of Medicare)

Ins. Median: $158 (488% 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 488% of the Medicare baseline (a markup of 388%). 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
Blue Cross Blue Shield	$62 - $184	191%
UnitedHealthcare	$65 - $169	201%
Health Alliance Mcr Adv - All Plans	$67	207%
Aetna	$73 - $179	225%
Meridian Mcaid - All Plans	$73	225%
Molina Mcaid - All Plans	$73	225%
Healthlink Hmo	$148	457%
Cigna	$158	488%
Encore Combined Ip/Op Only	$158	488%
Hope Trust - All Plans	$158	488%
Healthlink Ppo - All Other Plans	$169	522%
Phcs - All Plans	$169	522%
Health Smart - All Plans	$179	552%
Hfn - All Plans	$179	552%
Multiplan - All Plans	$179	552%
Siho Network - All Plans	$179	552%
Encore Health Network Ip/Op Only - All Other Plans	$190	586%

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 $211.
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 Wabash General Hospital 1 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.