CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: St Francis Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $147
Cash Discount Price: $132
vs. Medicare Baseline: 4.54x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at St Francis Hospital is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $132. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.54x the Medicare baseline. Located in 1215 Franciscan Dr, Litchfield, IL.

Cash / Self-Pay

$132

Average discount available for prompt cash payment at this facility.

Insurance Median

$147

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: $132 (407%)

Insurance Median: $147 (454%)

Cash: $132 (407% of Medicare)

Ins. Median: $147 (454% 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 454% of the Medicare baseline (a markup of 354%). 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
Wexford	$38	117%
Blue Cross Blue Shield	$38 - $42	117%
Clear Spring Health of Illinois	$38	117%
Humana	$38	117%
Molina Healthcare	$39 - $40	120%
UnitedHealthcare	$40 - $183	123%
Aetna	$40 - $129	123%
Meridian Health Plan	$41	127%
Amish Community	$51	157%
Celtic Insurance Company	$93	287%
Claim Doc	$96	296%
Hopetrust	$105	324%
Wellfirst	$118	364%
First Health	$136	420%
Caterpillar, Inc.	$147	454%
Current Health Solutions	$154	475%
Healthlink	$156	481%
Multiplan/Phcs	$156	481%
Consociate Group	$156	481%
Provider Network of America	$165	509%
Healthcare Finest Network (Hfn)	$165	509%
Live360	$183	565%
Interplan	$183	565%
Cigna	$183	565%
Health Alliance Medical Plans	$183	565%
Illinois Breast and Cervical Cancer Program	$183	565%
Healthscope	$183	565%
Naphcare	$183	565%

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 $132.
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 St Francis 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.