CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Methodist Hospitals Inc

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $145
Cash Discount Price: $141
vs. Medicare Baseline: 4.13x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Methodist Hospitals Inc is $145. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $141. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.13x the Medicare baseline. Located in 600 Grant St, Gary, IN.

Cash / Self-Pay

$141

Average discount available for prompt cash payment at this facility.

Insurance Median

$145

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $141 (402%)

Insurance Median: $145 (413%)

Cash: $141 (402% of Medicare)

Ins. Median: $145 (413% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 413% of the Medicare baseline (a markup of 313%). 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	$33 - $149	94%
Blue Cross Blue Shield	$33 - $200	94%
Humana	$33 - $186	94%
Medicare (plans)	$33	94%
United Heathcare	$33	94%
Zing	$34	97%
Caresource Maketplace	$55	157%
Ambetter / Centene	$67	191%
Cigna	$77 - $84	220%
Physicians Health Plan Of Northern Indiana	$116	331%
Encore	$121 - $179	345%
Phcs	$137	391%
Siho	$141	402%
Sagamore	$145	413%
Multiplan	$147	419%
Hfn	$157 - $171	448%
Magnacare	$159	453%
Caresource	$186	530%
Managed Health Services	$186	530%
Medicaid / KanCare	$186	530%
UnitedHealthcare	$186 - $313	530%

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 $141.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

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 97530.
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.