CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Southeast Georgia Health System -- Camden Campus

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $89
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Southeast Georgia Health System -- Camden Campus is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.75x the Medicare baseline. Located in 2000 Dan Proctor Drive, Saint Marys, GA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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%)

Insurance Median: $89 (275%)

Ins. Median: $89 (275% 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 275% of the Medicare baseline (a markup of 175%). 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
Amerigroup_Community_Care	$21	65%
Caresource_Georgia_Families	$21	65%
Peachstate_Health_Plan	$21	65%
Aetna	$31 - $125	96%
Blue Cross Blue Shield	$31 - $105	96%
Caresource	$31 - $46	96%
Clover_Health	$31	96%
Humana	$31 - $131	96%
UnitedHealthcare	$31	96%
United_Healthcare_Veterans_Administration	$31	96%
Devoted_Health	$32	99%
Pruitthealth	$32	99%
Ambetter / Centene	$49	151%
Sea_Island	$105	324%
Sghs_Meritain	$105	324%
Coventryone_Hix	$112	346%
United_Healthcare	$114	352%
Medishare	$125	386%
Choicecare	$131	404%
Cigna	$131	404%
Industry_Buying_Group_Ibg	$131	404%
First_Health_Southcare	$133	410%
One_Health_Great_West	$133	410%
Pponext	$140	432%

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 $X.
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 Southeast Georgia Health System -- Camden Campus 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.