CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Cannon Memorial Hospital
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $48
- Cash Discount Price: $65
- vs. Medicare Baseline: 1.48x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Cannon Memorial Hospital is $48. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.48x the Medicare baseline. Located in 123 W G Acker Drive, Pickens, SC.
Cash / Self-Pay
$65
Average discount available for prompt cash payment at this facility.
Insurance Median
$48
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: $65 (201%)
Insurance Median: $48 (148%)
Cash: $65 (201% of Medicare)
Ins. Median: $48 (148% 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.
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 |
|---|---|---|
| Absolute Total Care [58] | $23 - $44 | 71% |
| Medicaid / KanCare | $23 - $175 | 71% |
| Humana | $24 - $126 | 74% |
| Select Health Of Sc [637] | $26 - $41 | 80% |
| Cigna | $29 - $175 | 90% |
| Nalc Health Benefit Plan [291] | $29 - $104 | 90% |
| Aetna | $30 - $99 | 93% |
| Blue Choice Health Plan [922] | $30 - $100 | 93% |
| Blue Cross Blue Shield | $30 - $166 | 93% |
| Geha [302] | $30 - $93 | 93% |
| Golden Rule Ins Co [584] | $30 - $93 | 93% |
| Medicare (plans) | $30 - $175 | 93% |
| UnitedHealthcare | $30 - $175 | 93% |
| Vaccn - Va Community Care Network [16] | $30 | 93% |
| Veterans Administration [633] | $30 | 93% |
| Absolute Total Care Mcr Plans Alt Payer [4101] | $31 | 96% |
| Absolute Total Care Mcr Plans [41] | $31 | 96% |
| Champva [604] | $31 | 96% |
| Devoted Health Alt Payer [9401] | $31 | 96% |
| Devoted Health [94] | $31 | 96% |
| Molina Dual Options Alt Payer [1501] | $31 | 96% |
| Molina Dual Options [15] | $31 | 96% |
| Tricare | $31 | 96% |
| First Choice Vip Careplus Alt Payer [3301] | $32 | 99% |
| First Choice Vip [33] | $32 | 99% |
| Nhc Advantage Alt Payer [6101] | $32 | 99% |
| Nhc Advantage [61] | $32 | 99% |
| Bright Health Alt Payer [1001] | $34 | 105% |
| Planned Administrators [886] | $34 - $89 | 105% |
| Thomas Cooper & Company [315] | $34 - $89 | 105% |
| Employee Benefit Management Services [869] | $42 - $49 | 130% |
| Ambetter / Centene | $43 | 133% |
| Bright Health [11] | $43 | 133% |
| First Choice Next [96] | $44 | 136% |
| Molina Marketplace [97] | $44 | 136% |
| Mail Handlers Benefit Plan [327] | $48 - $99 | 148% |
| Rural Carrier Benefit Plan [406] | $48 - $99 | 148% |
| Workers Compensation [622] | $48 | 148% |
| Edison Health Solutions [95] | $53 | 164% |
| Healthscope [98] | $53 | 164% |
| Preferred Administrators [19] | $53 - $105 | 164% |
| Medcost [206] | $58 - $158 | 179% |
| Phcs [940] | $77 - $116 | 238% |
| Coventry Health [245] | $106 - $126 | 327% |
| Other Hospital Payers [1991] | $128 - $175 | 395% |
| American Continental Ins [778] | $170 - $175 | 525% |
| American Republic Life Ins [722] | $170 - $175 | 525% |
| Business Office [6000] | $170 - $175 | 525% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund [17] | $170 - $175 | 525% |
| First Health [946] | $170 - $175 | 525% |
| Guarantee Trust Life Insurance [236] | $170 - $175 | 525% |
| Home Health Infusion Payer [6001] | $170 - $175 | 525% |
| Manhattan Life Ins Co [932] | $170 - $175 | 525% |
| Miscellaneous Commercial [1] | $170 - $175 | 525% |
| New Era Life Ins Co [437] | $170 - $175 | 525% |
| Non-Contracted [22] | $170 - $175 | 525% |
| Physicians Mutual [773] | $170 - $175 | 525% |
| Reference Based Pricing/Limited Plan [21] | $170 - $175 | 525% |
| State Farm Ins Co [373] | $170 - $175 | 525% |
| Sterling Investors Life [244] | $170 - $175 | 525% |
| Supermed/Med Mutual Of Ohio [539] | $170 - $175 | 525% |
| United American Ins Co [277] | $170 - $175 | 525% |