CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Baptist Memorial Hospital Union County

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $132
Cash Discount Price: $50
vs. Medicare Baseline: 4.07x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Baptist Memorial Hospital Union County is $132. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.07x the Medicare baseline. Located in 200 Hwy 30 West, New Albany, MS.

Cash / Self-Pay

$50

Average discount available for prompt cash payment at this facility.

Insurance Median

$132

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: $50 (154%)

Insurance Median: $132 (407%)

Cash: $50 (154% of Medicare)

Ins. Median: $132 (407% 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 407% of the Medicare baseline (a markup of 307%). 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
Aetna	$21 - $139	65%
Advanced Health Systems Inc.	$35	108%
Blue Cross Blue Shield	$35	108%
Magnolia Ms	$42 - $47	130%
Ppo Holdings	$76 - $84	235%
Magnolia Regional Health Center	$80 - $89	247%
Littler	$100 - $111	309%
Molina	$100 - $111	309%
Mpcn	$103 - $115	318%
Cigna	$109 - $122	336%
Primewell	$119 - $133	367%
Humana	$131 - $147	404%
First Choice Health Plan Of Ms	$139 - $155	429%
Multiplan	$149 - $166	460%
Novasys	$149 - $166	460%
Christian Health Aid	$159 - $178	491%
UnitedHealthcare	$160 - $237	494%
Ppo Plus	$169 - $189	522%
Qca	$179 - $200	552%

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 $50.
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 Baptist Memorial Hospital Union County 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.