CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Methodist Hospitals Inc

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $84
Cash Discount Price: $82
vs. Medicare Baseline: 2.59x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Methodist Hospitals Inc is $84. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $82. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.59x the Medicare baseline. Located in 600 Grant St, Gary, IN.

Cash / Self-Pay

$82

Average discount available for prompt cash payment at this facility.

Insurance Median

$84

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: $82 (253%)

Insurance Median: $84 (259%)

Cash: $82 (253% of Medicare)

Ins. Median: $84 (259% 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 259% of the Medicare baseline (a markup of 159%). 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
Aetna	$31 - $93	96%
Blue Cross Blue Shield	$31 - $186	96%
Humana	$31 - $186	96%
Medicare (plans)	$31	96%
United Heathcare	$31	96%
Zing	$32	99%
Cigna	$43 - $53	133%
Caresource Maketplace	$51	157%
Ambetter / Centene	$62	191%
Physicians Health Plan Of Northern Indiana	$64 - $73	198%
Encore	$67 - $112	207%
Phcs	$75 - $86	231%
Siho	$78 - $88	241%
Sagamore	$80 - $91	247%
Multiplan	$81 - $92	250%
Hfn	$87 - $107	269%
Magnacare	$147	454%
Caresource	$186	574%
Managed Health Services	$186	574%
Medicaid / KanCare	$186	574%
UnitedHealthcare	$186 - $313	574%

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 $82.
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 Methodist Hospitals Inc 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.