CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Ochsner Stennis Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $94
Cash Discount Price: $107
vs. Medicare Baseline: 2.90x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Ochsner Stennis Memorial Hospital is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $107. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.90x the Medicare baseline. Located in 14365 Highway 16 West, De Kalb, MS.

Cash / Self-Pay

$107

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

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: $107 (330%)

Insurance Median: $94 (290%)

Cash: $107 (330% of Medicare)

Ins. Median: $94 (290% 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 290% of the Medicare baseline (a markup of 190%). 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
Blue Cross Blue Shield	$35 - $40	108%
Prime Health Services Ppo -Workers Comp	$50	154%
Cor Vel	$51	157%
Humana	$63 - $93	194%
Cigna	$75 - $93	231%
UnitedHealthcare	$79 - $110	244%
Medicare (plans)	$93 - $106	287%
Ambetter / Centene	$94	290%
Magnolia Health Plan – Wellcare By All Well Of Mississippi	$94	290%
Shared Health Mississippi	$97	299%
Aetna	$100	309%
Primewell Health Services Commercial Exchange Plan	$103	318%
Primewell Health Services – Commercial	$103	318%
Select Administrative Services Network	$108	333%
Claritev D/B/A Multiplan/Phcs/American Life Care	$116	358%
Zelis	$116	358%
Prime Health Services Ppo	$123	380%

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 $107.
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 Ochsner Stennis Memorial 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.