CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Southern Ocean Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $167
Cash Discount Price: $41
vs. Medicare Baseline: 5.15x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Southern Ocean Medical Center is $167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $41. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 5.15x the Medicare baseline. Located in 1140 Rt 72 W, Manahawkin, NJ.

Cash / Self-Pay

$41

Average discount available for prompt cash payment at this facility.

Insurance Median

$167

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: $41 (127%)

Insurance Median: $167 (515%)

Cash: $41 (127% of Medicare)

Ins. Median: $167 (515% 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 515% of the Medicare baseline (a markup of 415%). 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
Clover	$35	108%
Aetna	$36 - $181	111%
Seoul Medical Group	$40	123%
Amerigroup	$41	127%
Vaccn	$41	127%
United Community/Americhoice	$43	133%
UnitedHealthcare	$49 - $407	151%
Karna	$54	167%
Horizon	$60 - $179	185%
Cigna	$157 - $187	485%
Qualcare	$160 - $257	494%
Multiplan - PHCS	$167	515%
Amerihealth	$170 - $193	525%
Brighton Health Plan	$176	543%
Wellcare	$224	691%
Bergen Risk	$291	898%
Oxford	$563	1738%

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 $41.
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 Southern Ocean Medical Center 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.