CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Curry General Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $166
Cash Discount Price: $175
vs. Medicare Baseline: 5.12x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Curry General Hospital is $166. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $175. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 5.12x the Medicare baseline. Located in 94220 Fourth Street, Gold Beach, OR.

Cash / Self-Pay

$175

Average discount available for prompt cash payment at this facility.

Insurance Median

$166

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: $175 (540%)

Insurance Median: $166 (512%)

Cash: $175 (540% of Medicare)

Ins. Median: $166 (512% 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 512% of the Medicare baseline (a markup of 412%). 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
Partnership Health Plan Of Calif Mdcd Hmo [2008]	$8	25%
Tricare	$54	167%
Covid19 Hrsa Uninsured Testing And Treatment Fund [2271]	$76	235%
Medicare (plans)	$76 - $114	235%
Blue Cross Blue Shield	$89 - $175	275%
First Choice Health Admin [1294]	$97	299%
First Choice [528]	$97	299%
Medicaid / KanCare	$110 - $114	340%
Department Of Corrections [1051]	$114	352%
Coordinated Care Commercial [1649]	$149	460%
Pacificsource [1148]	$149	460%
Moda [512]	$150 - $158	463%
Multiplan [1131]	$159	491%
Asuris [1258]	$166	512%
Operating Engineers [1144]	$166	512%
Regence [1351]	$166 - $175	512%
Cigna	$172 - $175	531%
Coventry First Health Managed Care [1774]	$172	531%
Coventry Health [1046]	$172	531%
Providence Health Plan Plm Alt [1692]	$172	531%
Providence Health Plan [567]	$172	531%
Aetna	$175	540%
Employee Bene Admin Mgmt [525]	$175	540%
Geha [531]	$175	540%
Mailhandlers Benefit Pln [547]	$175	540%
Meritain [550]	$175	540%
Nw Sheet Metal Workers [597]	$175	540%
Trustmark [524]	$175	540%
UnitedHealthcare	$175	540%
Zenith Administrators [586]	$175	540%
Allcare Alt [2598]	$300	926%
Allcare [1695]	$300	926%

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 $175.
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 Curry General 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.