CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Memorial Hospital at Gulfport

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $140
Cash Discount Price: $238
vs. Medicare Baseline: 4.32x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Memorial Hospital at Gulfport is $140. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $238. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.32x the Medicare baseline. Located in 4500 13Th Street, Gulfport, MS.

Cash / Self-Pay

$238

Average discount available for prompt cash payment at this facility.

Insurance Median

$140

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: $238 (735%)

Insurance Median: $140 (432%)

Cash: $238 (735% of Medicare)

Ins. Median: $140 (432% 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 432% of the Medicare baseline (a markup of 332%). 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
Cigna	$31 - $255	96%
Blue Cross Blue Shield	$35 - $42	108%
Sas Mhg	$42 - $244	130%
Humana	$43 - $287	133%
Magnolia Health	$43 - $180	133%
Molina	$65	201%
Primewell	$98	302%
Fox Everett	$112 - $160	346%
Sas Non-Mhg	$112 - $160	346%
UnitedHealthcare	$127 - $181	392%
Aetna	$140 - $200	432%
First Choice	$140 - $287	432%
Mhg	$140 - $200	432%
First Health	$202 - $287	623%
Mpcn	$210 - $299	648%

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 $238.
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 Memorial Hospital at Gulfport 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.