CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Stonewall Jackson Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $179
Cash Discount Price: $103
vs. Medicare Baseline: 5.52x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Stonewall Jackson Memorial Hospital is $179. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $103. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 5.52x the Medicare baseline. Located in 230 Hospital Plaza, Weston, WV.

Cash / Self-Pay

$103

Average discount available for prompt cash payment at this facility.

Insurance Median

$179

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: $103 (318%)

Insurance Median: $179 (552%)

Cash: $103 (318% of Medicare)

Ins. Median: $179 (552% 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 552% of the Medicare baseline (a markup of 452%). 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
Medicaid / KanCare	$22 - $23	68%
Blue Cross Blue Shield	$23	71%
Aetna	$31 - $179	96%
Alliance_Ppo	$150	463%
Onenet	$163 - $193	503%
Cigna	$170 - $202	525%
Healthsmart_Accel	$170 - $201	525%
Healthsmart_Auto	$170 - $201	525%
Healthsmart_Hpo	$170 - $201	525%
Healthsmart_Ppo	$170 - $201	525%
Sharpe	$170 - $201	525%
UnitedHealthcare	$176 - $208	543%
Ccn	$179 - $213	552%
Multiplan	$179 - $213	552%
Napp	$184 - $218	568%
4_Most	$185 - $219	571%

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 $103.
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 Stonewall Jackson 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.