CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Baptist Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $119
Cash Discount Price: $44
vs. Medicare Baseline: 3.67x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Baptist Memorial Hospital is $119. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $44. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.67x the Medicare baseline. Located in 6019 Walnut Grove Road, Memphis, TN.

Cash / Self-Pay

$44

Average discount available for prompt cash payment at this facility.

Insurance Median

$119

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: $44 (136%)

Insurance Median: $119 (367%)

Cash: $44 (136% of Medicare)

Ins. Median: $119 (367% 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 367% of the Medicare baseline (a markup of 267%). 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	$16 - $134	49%
Aetna	$21 - $58	65%
Magnolia Tn	$40 - $45	123%
Humana	$64	198%
Ppo Holdings	$76 - $85	235%
Cooper Realty	$80 - $90	247%
Magnolia Regional Health Center	$80 - $90	247%
Multiplan	$86 - $168	265%
Littler	$100 - $112	309%
Molina	$100 - $112	309%
Ppo Plus	$100 - $179	309%
Mpcn	$103 - $116	318%
First Choice Health Plan Of Ms	$105 - $119	324%
Novasys	$115 - $130	355%
Access Health Services	$119 - $134	367%
Butler Snow	$119 - $134	367%
UnitedHealthcare	$119 - $134	367%
Oscar	$130	401%
Qca	$149 - $168	460%
Christian Health Aid	$159 - $179	491%
St. Jude Children'S Hospital	$179 - $202	552%

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 $44.
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 Baptist 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.