CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Sarah D Culbertson Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $148
Cash Discount Price: $161
vs. Medicare Baseline: 4.57x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Sarah D Culbertson Memorial Hospital is $148. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $161. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.57x the Medicare baseline. Located in 238 South Congress Street, Rushville, IL.

Cash / Self-Pay

$161

Average discount available for prompt cash payment at this facility.

Insurance Median

$148

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: $161 (497%)

Insurance Median: $148 (457%)

Cash: $161 (497% of Medicare)

Ins. Median: $148 (457% 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 457% of the Medicare baseline (a markup of 357%). 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	$67 - $190	207%
Humana	$71 - $83	219%
Molina Mmai-All Other Plans	$71 - $83	219%
UnitedHealthcare	$71 - $175	219%
Aetna	$72 - $175	222%
Corvel-All Plans	$99	306%
Meridian Hp Mcaid-All Plans	$99	306%
Molina Healthcare Mcaid	$99	306%
Cigna	$121 - $143	373%
Beech Street-All Plans	$148 - $175	457%
Encompass-All Plans	$148 - $175	457%
Health Dynamics-All Plans	$148 - $175	457%
Healthlink-All Plans	$148 - $175	457%
Hfn Epo	$148 - $175	457%
Hfn Ppo Ip/Op Only-All Other Plans	$148 - $175	457%
Multiplan/Phcs-All Plans	$148 - $175	457%
Preferred Medical Claims Solution-All Plans	$148 - $175	457%
Three Rivers Provider Network-All Plans	$148 - $175	457%
Wexford Ip/Op Only-All Plans	$148 - $175	457%
Healthsmart-All Plans	$156 - $184	481%

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 $161.
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 Sarah D Culbertson Memorial 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.