CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Decatur County Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $218
Cash Discount Price: $330
vs. Medicare Baseline: 6.73x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Decatur County Memorial Hospital is $218. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $330. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 6.73x the Medicare baseline. Located in 720 North Lincoln Street, Greensburg, IN.

Cash / Self-Pay

$330

Average discount available for prompt cash payment at this facility.

Insurance Median

$218

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: $330 (1019%)

Insurance Median: $218 (673%)

Cash: $330 (1019% of Medicare)

Ins. Median: $218 (673% 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 673% of the Medicare baseline (a markup of 573%). 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	$47 - $753	145%
Choice Care Mcr Adv	$47 - $218	145%
Siho Mcr Adv	$47 - $218	145%
UnitedHealthcare	$47 - $218	145%
Caresource Mcr Adv	$49 - $229	151%
Aetna	$55 - $572	170%
Caresource Just4Me-All Other Plans	$79 - $371	244%
Cigna	$124 - $580	383%
Sagamore Health-All Plans	$129 - $602	398%
Encircle-All Plans	$137 - $640	423%
Healthsource Indiana-All Plans	$145 - $678	448%
Choicecare Commercial-All Other Plans	$150 - $700	463%
Thcg/Encore-All Plans	$151 - $708	466%
Siho-All Other Plans	$156 - $730	481%
Medicaid / KanCare	$161 - $753	497%

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 $330.
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 Decatur 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.