CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Yalobusha General Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $32
Cash Discount Price: $69
vs. Medicare Baseline: 0.91x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Yalobusha General Hospital is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $69. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 0.91x the Medicare baseline. Located in 630 South Main Street, Water Valley, MS.

Cash / Self-Pay

$69

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $69 (197%)

Insurance Median: $32 (91%)

Cash: $69 (197% of Medicare)

Ins. Median: $32 (91% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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
Magnolia	$28 - $32	80%
Molina	$28 - $32	80%
True Care	$28	80%
Aetna	$29	83%
UnitedHealthcare	$32	91%
Vantage Health Plan	$32	91%
Wellcare	$32	91%
Blue Cross Blue Shield	$79	225%

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 $69.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Yalobusha General Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
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.