CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Jacksonville Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $152
Cash Discount Price: $247
vs. Medicare Baseline: 4.69x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Jacksonville Memorial Hospital is $152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $247. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.69x the Medicare baseline. Located in 1600 W Walnut St, Jacksonville, IL.

Cash / Self-Pay

$247

Average discount available for prompt cash payment at this facility.

Insurance Median

$152

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: $247 (762%)

Insurance Median: $152 (469%)

Cash: $247 (762% of Medicare)

Ins. Median: $152 (469% 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 469% of the Medicare baseline (a markup of 369%). 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	$29 - $271	90%
Coventry	$31 - $43	96%
Health Alliance	$31 - $184	96%
Humana	$31 - $231	96%
Medicare (plans)	$31 - $43	96%
Tricare	$31 - $49	96%
UnitedHealthcare	$32 - $195	99%
Corvel/Corcare	$42 - $67	130%
Illinois Workers Compensation	$45 - $63	139%
Medicaid / KanCare	$59	182%
Molina Healthcare	$59	182%
Commercial Workers Compensation	$60	185%
Health Alliance Mh Employee Plan	$103 - $125	318%
Current Health Network	$123 - $203	380%
6 Degrees Health	$134 - $163	414%
Hope Trust	$134 - $163	414%
Hst	$134 - $163	414%
Cigna	$155 - $188	478%
Aetna	$156 - $217	481%
Healthlink	$190 - $230	586%
Phcs/Multiplan	$201 - $244	620%
Hfn	$212 - $257	654%
Liability	$223 - $271	688%

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 $247.
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 Jacksonville 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.