CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Henry County Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $95
Cash Discount Price: $99
vs. Medicare Baseline: 2.93x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Henry County Memorial Hospital is $95. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $99. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.93x the Medicare baseline. Located in 1000 N 16Th St, New Castle, IN.

Cash / Self-Pay

$99

Average discount available for prompt cash payment at this facility.

Insurance Median

$95

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: $99 (306%)

Insurance Median: $95 (293%)

Cash: $99 (306% of Medicare)

Ins. Median: $95 (293% 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 293% of the Medicare baseline (a markup of 193%). 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	$31 - $141	96%
Caresource Hip	$31	96%
Humana	$31 - $124	96%
Caresource Mcr Adv	$32	99%
Caresource Marketplace-All Other Plans	$59	182%
Caresource Just4Me	$77	238%
Cigna	$96	296%
UnitedHealthcare	$115	355%
Aetna	$120	370%
Health Alliance-All Plans	$120	370%
Workers Comp - All Plans	$127	392%
Encore Workers Comp-All Plans	$134	414%
Caresource Mcaid	$145	448%

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 $99.
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 Henry County 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.