CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Franciscan Health Indianapolis

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $126
Cash Discount Price: $45
vs. Medicare Baseline: 3.89x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Franciscan Health Indianapolis is $126. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.89x the Medicare baseline. Located in 8111 S Emerson Ave, Indianapolis, IN.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$126

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: $45 (139%)

Insurance Median: $126 (389%)

Cash: $45 (139% of Medicare)

Ins. Median: $126 (389% 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 389% of the Medicare baseline (a markup of 289%). 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
Research/Grant [2012]	$5	15%
Medicare (plans)	$31 - $34	96%
Managed Care [2000]	$47 - $208	145%
Aetna	$61 - $143	188%
Blue Cross Blue Shield	$61 - $62	188%
Unicare [1150]	$61 - $62	188%
Workers Comp [1172]	$62	191%
Commercial [2001]	$72 - $208	222%
UnitedHealthcare	$107 - $126	330%
United Medical Resources [1158]	$109 - $126	336%
United Medical Resources [1301]	$109 - $126	336%
Cigna	$115 - $132	355%
Great West Insurance [1055]	$117 - $135	361%
Humana	$125 - $145	386%
Mdwise [1175]	$186	574%
Medicaid / KanCare	$186 - $224	574%
Managed Health Services [1302]	$192	593%

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 $45.
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 Franciscan Health Indianapolis 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.