CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Stephens County Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $53
Cash Discount Price: $51
vs. Medicare Baseline: 1.64x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Stephens County Hospital is $53. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $51. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.64x the Medicare baseline. Located in 163 Hospital Drive, Toccoa, GA.

Cash / Self-Pay

$51

Average discount available for prompt cash payment at this facility.

Insurance Median

$53

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: $51 (157%)

Insurance Median: $53 (164%)

Cash: $51 (157% of Medicare)

Ins. Median: $53 (164% 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
Amerigroup	$6 - $45	19%
Medicaid / KanCare	$6 - $46	19%
Blue Cross Blue Shield	$16 - $111	49%
Aetna	$17 - $118	52%
Cigna	$18 - $125	56%
UnitedHealthcare	$18 - $122	56%
Caresource	$20 - $139	62%
Medicare (plans)	$20 - $139	62%

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 $51.
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 Stephens County 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.