CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Wayne General Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $64
Cash Discount Price: $74
vs. Medicare Baseline: 1.98x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Wayne General Hospital is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $74. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.98x the Medicare baseline. Located in 950 Matthew Dr, Waynesboro, MS.

Cash / Self-Pay

$74

Average discount available for prompt cash payment at this facility.

Insurance Median

$64

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: $74 (228%)

Insurance Median: $64 (198%)

Cash: $74 (228% of Medicare)

Ins. Median: $64 (198% 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
Humana	$27	83%
Ml Healthcare-All Plans	$29 - $30	90%
Amerigroup Mcare Adv-All Plans	$30	93%
Cigna	$30 - $52	93%
Magnolia Mcare Adv	$30	93%
Molina Mcare Adv	$30	93%
Vantage Health Mcare Adv	$30	93%
Wellcare Mcare Adv-All Plans	$30	93%
Ahs-All Plans	$50 - $52	154%
Phcs-All Plans	$54 - $56	167%
Mhci/Healthlink Op Only-All Plans	$61 - $64	188%
Ms Health Partners-All Plans	$61 - $64	188%
Ppoplus-All Plans	$61 - $64	188%
First Choice-All Other Plans	$65 - $68	201%
First Health-All Plans	$65 - $68	201%
Geha Ppo-All Plans	$65 - $68	201%
Healthcare Advantage-All Plans	$65 - $68	201%
United Providers-All Plans	$65 - $68	201%
Three Rivers Provider Network-All Plans	$68 - $71	210%
Vantage Health-All Other Plans	$69	213%
Aetna	$72 - $75	222%
Magnolia Comm/Exchange-All Other Plans	$72 - $75	222%
First Choice Hie	$90 - $94	278%
Blue Cross Blue Shield	$135 - $140	417%

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 $74.
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 Wayne General Hospital 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.