CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Southern Regional Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $34
Cash Discount Price: $32
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Southern Regional Medical Center is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $32. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.05x the Medicare baseline. Located in 11 Upper Riverdale Road, Sw, Riverdale, GA.

Cash / Self-Pay

$32

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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: $32 (99%)

Insurance Median: $34 (105%)

Cash: $32 (99% of Medicare)

Ins. Median: $34 (105% 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	$22 - $33	68%
Humana	$31 - $64	96%
Americas Choice Provider Network	$33	102%
Blue Cross Blue Shield	$33 - $177	102%
Cigna	$33 - $56	102%
Clear Spring Health Plan	$33	102%
Corvel	$33	102%
Georgia Workers’ Compensation	$33	102%
Medicare (plans)	$33	102%
Multiplan	$33	102%
Novanet	$33	102%
Prime Health Services	$33	102%
Provider Select	$33	102%
Riverwood Behavioral Health	$33 - $41	102%
Three Rivers	$33	102%
Tricare	$33	102%
UnitedHealthcare	$33	102%
Caresource	$34 - $57	105%
Devoted Health	$34	105%
Peach State	$34 - $39	105%
Sonder Health Plan	$34	105%
Wellcare	$34	105%
Oscar Health Plan	$43	133%
Employer Direct Healthcare	$46	142%
Centurion	$49	151%
Naphcare	$51	157%
Therapy Network Of Ga	$189 - $246	583%

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 $32.
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 Southern 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.