CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Perry County Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $150
Cash Discount Price: $252
vs. Medicare Baseline: 4.63x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Perry County Memorial Hospital is $150. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $252. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.63x the Medicare baseline. Located in 8885 Sr 237, Tell City, IN.

Cash / Self-Pay

$252

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

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: $252 (778%)

Insurance Median: $150 (463%)

Cash: $252 (778% of Medicare)

Ins. Median: $150 (463% 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 463% of the Medicare baseline (a markup of 363%). 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
Medicaid / KanCare	$33 - $576	102%
Veterans Administration	$36 - $576	111%
Bc 130	$37 - $460	114%
Group Insurance	$37 - $576	114%
Medicare (plans)	$37 - $150	114%
Workers Compensation	$72 - $288	222%
Nsa	$84 - $356	259%
Guarantor Liable	$100 - $576	309%
Pcmh Insurnace	$112 - $576	346%
Secondary Insurance	$114 - $460	352%
UnitedHealthcare	$114 - $460	352%
Operating Engineers	$122 - $490	377%
Boilermakers Healthcare	$124 - $501	383%
Cigna	$124 - $501	383%
Great West	$124 - $576	383%
Sagxxxx	$124 - $501	383%
Champus	$143 - $576	441%
Ngs American, Inc	$143 - $576	441%
Patoka Valley	$143 - $576	441%
Southwire	$143 - $576	441%
Tricare	$143 - $576	441%
Wausau Benefits	$143 - $576	441%

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 $252.
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 Perry 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.