CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Breckinridge Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $54
Cash Discount Price: $60
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Breckinridge Memorial Hospital is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $60. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.67x the Medicare baseline. Located in 1011 Old Highway 60, Hardinsburg, KY.

Cash / Self-Pay

$60

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

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: $60 (185%)

Insurance Median: $54 (167%)

Cash: $60 (185% of Medicare)

Ins. Median: $54 (167% 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.

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	$15 - $116	46%
Blue Cross Blue Shield	$15 - $154	46%
Wellcare Mcaid - All Other Plans	$15	46%
Tricare	$28 - $50	86%
Molina Mcr Adv - All Plans	$29 - $53	90%
University Health Care - All Other Plans	$30 - $54	93%
Caresource - All Plans	$31 - $55	96%
UnitedHealthcare	$31 - $131	96%
University Health Care Mcr Adv	$31 - $55	96%
Wellcare Mcr Adv	$31 - $55	96%
Ambetter / Centene	$34 - $61	105%
Humana	$64 - $116	198%

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 $60.
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 Breckinridge 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.