CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Claiborne Memorial Medical Center
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $105
- Cash Discount Price: $128
- vs. Medicare Baseline: 3.24x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Claiborne Memorial Medical Center is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.24x the Medicare baseline. Located in 620 East College Street, Homer, LA.
Cash / Self-Pay
$128
Average discount available for prompt cash payment at this facility.
Insurance Median
$105
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: $128 (395%)
Insurance Median: $105 (324%)
Cash: $128 (395% of Medicare)
Ins. Median: $105 (324% 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 324% of the Medicare baseline (a markup of 224%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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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 | $29 - $98 | 90% |
| Arcadian Community Mcr Hm | $29 | 90% |
| Blue Cross Blue Shield | $29 - $99 | 90% |
| Champus | $29 | 90% |
| Champva | $29 | 90% |
| Cigna | $29 - $112 | 90% |
| Healthy Blue Dual Adv | $29 | 90% |
| Humana | $29 - $150 | 90% |
| Kaiser Foundation Health | $29 | 90% |
| Medicare (plans) | $29 | 90% |
| Peoples Health Network | $29 | 90% |
| Pyramid Claims Mcr Hmo | $29 | 90% |
| Sterling Connect 2 | $29 | 90% |
| Sterling Premier Mc Hmo | $29 | 90% |
| Superior Health Mcr Hmo | $29 | 90% |
| Tenet Mcr Hmo | $29 | 90% |
| Tricare | $29 | 90% |
| United Hc Mcr Hmo | $29 | 90% |
| UnitedHealthcare | $29 - $64 | 90% |
| Universal Hc Mcr Hmo | $29 | 90% |
| Us Dept Of Labor | $29 | 90% |
| Vantage Health Mcr Hmo | $29 | 90% |
| Windsor Sterling Mcr Hmo | $29 | 90% |
| Wps Mvh Vapc3 | $29 | 90% |
| Vantage Health Plan Inc | $32 - $36 | 99% |
| Commercial Insurance | $42 - $150 | 130% |
| Meritain Health | $42 - $98 | 130% |
| Amerihealth Caritas La | $45 - $64 | 139% |
| Community Health Solution | $45 - $64 | 139% |
| Correctcare Intergrated | $45 - $64 | 139% |
| Healthy Blue | $45 - $64 | 139% |
| Louisiana Hc Connections | $45 - $64 | 139% |
| Magellan Services | $45 - $64 | 139% |
| Medicaid / KanCare | $45 - $64 | 139% |
| Sedgwick Claims Mgmt Serv | $45 - $135 | 139% |
| Workman'S Comp | $45 - $135 | 139% |
| Coventry Healthcare | $63 - $90 | 194% |
| Geha | $74 - $105 | 228% |
| Health Plus Of La | $74 - $112 | 228% |
| Apwu Healthplan | $79 - $112 | 244% |
| Great West Healthcare | $79 - $112 | 244% |
| Phcs | $84 - $120 | 259% |
| Ppo Plus | $84 - $120 | 259% |
| Aarp | $105 - $150 | 324% |
| Accordia National | $105 - $150 | 324% |
| Aflac | $105 - $150 | 324% |
| Alameda Alliance Forhealt | $105 - $150 | 324% |
| American Pioneer | $105 - $150 | 324% |
| Benefit Management | $105 - $150 | 324% |
| Benesys Inc | $105 - $150 | 324% |
| Business Guarantor | $105 - $150 | 324% |
| Chubb | $105 - $150 | 324% |
| Commercial Sr. Care | $105 - $150 | 324% |
| Employee Benefit Services | $105 - $150 | 324% |
| Family Life Insurance Co | $105 - $150 | 324% |
| Farm Bureau Insurance | $105 - $150 | 324% |
| Fiserv Health Benefit | $105 - $150 | 324% |
| Gmp | $105 - $150 | 324% |
| Group And Pension Admin | $105 - $150 | 324% |
| Group Resources | $105 - $150 | 324% |
| Haik Minvielle And Grubbs | $105 - $150 | 324% |
| Harrington Benefit Svs | $105 - $150 | 324% |
| Health Design Plus | $105 - $150 | 324% |
| Health Plan | $105 - $150 | 324% |
| Healthscope Benefits | $105 - $150 | 324% |
| Insurance Management Admi | $105 - $150 | 324% |
| Jefferson National | $105 - $150 | 324% |
| John Alden Health Ins | $105 - $150 | 324% |
| John Hancock | $105 - $150 | 324% |
| Liberty Mutual | $105 - $150 | 324% |
| Mailhandlers Benefit Plan | $105 - $150 | 324% |
| Manhattan Life Ins Co | $105 - $150 | 324% |
| Mega Life And Health | $105 - $150 | 324% |
| Msa Careguard | $105 - $150 | 324% |
| Mutual Of Omaha | $105 - $150 | 324% |
| Nalc Health Benefit Plan | $105 - $150 | 324% |
| Naphcare Inc. | $105 - $150 | 324% |
| New Era Life Ins Co | $105 - $150 | 324% |
| Physicians Mutual | $105 - $150 | 324% |
| Principal Financial Group | $105 - $150 | 324% |
| Prudential Healthcare | $105 - $150 | 324% |
| Self Pay | $105 - $150 | 324% |
| State Farm | $105 - $150 | 324% |
| State Farm Insurance | $105 - $150 | 324% |
| State Mutual Insurance Co | $105 - $150 | 324% |
| Sterling Investors Life | $105 - $150 | 324% |
| Tower Life | $105 - $150 | 324% |
| Transamerica Premier Ins | $105 - $150 | 324% |
| United American | $105 - $150 | 324% |
| United Comm Travelers | $105 - $150 | 324% |
| United Teachers | $105 - $150 | 324% |
| Usable Administrator | $105 - $150 | 324% |
| Visn 16 Cfu | $105 - $150 | 324% |
| Wausau Benefits | $105 - $150 | 324% |
| Webtpa | $105 - $150 | 324% |
| Wells Fargo | $105 - $150 | 324% |
| Woodmen Of The World | $105 - $150 | 324% |