CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Indiana Regional Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $32
Cash Discount Price: $62
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Indiana Regional Medical Center is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.99x the Medicare baseline. Located in 835 Hospital Road, Indiana, PA.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $62 (191%)

Insurance Median: $32 (99%)

Cash: $62 (191% of Medicare)

Ins. Median: $32 (99% 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
Highmark Wholecare	$21 - $31	65%
Amerihealth Caritas	$23 - $32	71%
Upmc Health Plan	$24 - $110	74%
Highmark	$26 - $97	80%
Humana	$30	93%
Aetna	$31 - $95	96%
Cigna	$31 - $98	96%
Medicare (plans)	$31	96%
Tricare	$31 - $172	96%
United Mine Workers Of America	$31	96%
UnitedHealthcare	$31 - $69	96%
Ambetter / Centene	$32 - $69	99%
Geisinger Health Plan	$32	99%
Geisinger	$43 - $87	133%
Pa Health And Wellness Commercial	$43 - $87	133%
Department Of Human Services And Torrance State Hospital	$108	333%
Premier Comp Solutions, Llc	$155	478%
Miscellaneous Commercial	$172	531%
Pa Workers Compensation	$172	531%

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 $62.
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 Indiana Regional Medical Center 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.