CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Norton Scott Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $128
Cash Discount Price: $42
vs. Medicare Baseline: 3.95x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Norton Scott Hospital is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.95x the Medicare baseline. Located in 1451 N Gardner St, Scottsburg, IN.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

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: $42 (130%)

Insurance Median: $128 (395%)

Cash: $42 (130% of Medicare)

Ins. Median: $128 (395% 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 395% of the Medicare baseline (a markup of 295%). 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
Molina Healthcare	$31 - $32	96%
UnitedHealthcare	$31 - $142	96%
Blue Cross Blue Shield	$39 - $140	120%
Managed Health Services (Mhs)	$42 - $57	130%
Managed Health Services (Mhs) Healthy Indiana Plan (Hip)	$42 - $57	130%
Mdwise Healthy Indiana Plan (Hip)	$42 - $57	130%
Communicare Advantage	$44 - $59	136%
Caresource Indiana Just4Me	$64 - $86	198%
Aetna	$112 - $151	346%
Multiplan	$142 - $203	438%
Cigna	$150 - $203	463%
Encore Health Network	$150 - $203	463%
Prime Health	$150 - $203	463%
Ppom	$156 - $210	481%
Intercommunity Health Network (Ihn)	$159 - $215	491%

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 $42.
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 Norton Scott 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.