CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Baptist Memorial Hospital Tipton

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $122
Cash Discount Price: $54
vs. Medicare Baseline: 3.48x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Baptist Memorial Hospital Tipton is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $54. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.48x the Medicare baseline. Located in 1995 Highway 51 S, Covington, TN.

Cash / Self-Pay

$54

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $54 (154%)

Insurance Median: $122 (348%)

Cash: $54 (154% of Medicare)

Ins. Median: $122 (348% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 348% of the Medicare baseline (a markup of 248%). 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
Magnolia Tn	$15 - $20	43%
Aetna	$24 - $79	68%
Blue Cross Blue Shield	$33 - $157	94%
Humana	$72	205%
Ppo Holdings	$77 - $100	220%
Magnolia Regional Health Center	$81 - $105	231%
Multiplan	$87 - $196	248%
Littler	$101 - $131	288%
Molina	$101 - $131	288%
Access Health Services	$121 - $157	345%
Butler Snow	$121 - $157	345%
UnitedHealthcare	$121 - $157	345%
Oscar	$130	371%
First Choice Health Plan Of Ms	$141 - $183	402%
Mpcn	$152 - $196	433%
Novasys	$152 - $196	433%
Ppo Plus	$172 - $223	490%
Qca	$182 - $236	519%
Cigna	$185 - $204	528%

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 $54.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Baptist Memorial Hospital Tipton is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97530.
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.