CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Norton-King's Daughters' Health

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $160
Cash Discount Price: $41
vs. Medicare Baseline: 4.56x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Norton-King's Daughters' Health is $160. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.56x the Medicare baseline. Located in 1373 East Sr 62, Madison, IN.

Cash / Self-Pay

$41

Average discount available for prompt cash payment at this facility.

Insurance Median

$160

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: $41 (117%)

Insurance Median: $160 (456%)

Cash: $41 (117% of Medicare)

Ins. Median: $160 (456% 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 456% of the Medicare baseline (a markup of 356%). 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	$22 - $167	63%
Blue Cross Blue Shield	$22 - $56	63%
Humana	$22 - $33	63%
Managed Health Services Of Kentucky	$22	63%
Passport By Molina	$22	63%
UnitedHealthcare	$33 - $149	94%
Managed Health Services	$34 - $51	97%
Caresource Of Kentucky	$46	131%
Caresource Of Indiana	$49	140%
Custom Design Benefits	$66 - $95	188%
Cigna	$152 - $162	433%
Encore	$152 - $162	433%
Quality Care Partners	$159 - $169	453%
Bluegrass	$161 - $171	459%
First Health	$161 - $171	459%
Healthlink	$161 - $171	459%
Vha/Tristate	$161 - $171	459%
Multiplan/Phcs	$165 - $175	470%
Indiana Health Network	$170 - $180	485%
Siho	$170 - $180	485%

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 $41.
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 Norton-King's Daughters' Health 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.