CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Mercy Hospital Fort Smith
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $43
- Cash Discount Price: $73
- vs. Medicare Baseline: 1.33x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital Fort Smith is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $73. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.33x the Medicare baseline. Located in 7301 Rogers Ave, Fort Smith, AR.
Cash / Self-Pay
$73
Average discount available for prompt cash payment at this facility.
Insurance Median
$43
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: $73 (225%)
Insurance Median: $43 (133%)
Cash: $73 (225% of Medicare)
Ins. Median: $43 (133% 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 |
|---|---|---|
| Mercy Interfacility [20513] | $25 | 77% |
| Medicaid / KanCare | $28 - $43 | 86% |
| Aetna | $29 - $84 | 90% |
| American Health Advantage Of Mo Mcr [20264] | $29 | 90% |
| Blue Cross Blue Shield | $29 - $38 | 90% |
| Cherokee Nation Health Serv Contracted [320066] | $29 | 90% |
| Cross Timbers Hospice [20098] | $29 | 90% |
| Dept Of Veteran Affairs Contracted [320106] | $29 | 90% |
| Elara Caring Aspire Hospice Contracted [320433] | $29 | 90% |
| Elara Caring Aspire Hospice [20433] | $29 | 90% |
| Globalhealth Contracted [320145] | $29 | 90% |
| Halo Hcr Inc Hospice Contracted [320432] | $29 | 90% |
| Halo Hcr Inc Hospice [20432] | $29 | 90% |
| Humana | $29 - $90 | 90% |
| Independent Health [20197] | $29 | 90% |
| Jordan Valley Senior Care Pace [20515] | $29 | 90% |
| Kindful Hospice Contracted [320434] | $29 | 90% |
| Kindful Hospice [20434] | $29 | 90% |
| Medical Associates Health [20444] | $29 | 90% |
| Medicare (plans) | $29 - $30 | 90% |
| Mercy Hospice Okc [20252] | $29 | 90% |
| Pace Of The Ozarks [20518] | $29 | 90% |
| Provider Partners Health Plans Contracted [320450] | $29 | 90% |
| Qual Choice Contracted [320325] | $29 | 90% |
| Spina Bifida Hlthcare Benefit [20506] | $29 | 90% |
| Tribute Health Plan Mcr [20338] | $29 | 90% |
| Tricare | $29 | 90% |
| UnitedHealthcare | $29 - $186 | 90% |
| Valir Pace [20503] | $29 | 90% |
| Wellfirst Health Mcr [20443] | $29 | 90% |
| Cigna | $30 - $168 | 93% |
| Usable Contracted [320409] | $38 | 117% |
| Ambetter / Centene | $43 | 133% |
| Home State Health Plan Contracted [320187] | $43 | 133% |
| Novasys Contracted [320285] | $43 - $140 | 133% |
| Aither Health Contracted [320449] | $45 | 139% |
| Edison Health Solutions Contracted [320502] | $45 | 139% |
| Mercy Benefit Admin Contracted [320251] | $45 - $67 | 139% |
| Health Choice Contracted [320166] | $46 | 142% |
| 90 Degree Benefits Contracted [320436] | $56 | 173% |
| Show-Me Health Administrators Contracted [320483] | $56 | 173% |
| Auxiant Contracted [320462] | $67 - $73 | 207% |
| Ebms Contracted [320493] | $67 | 207% |
| Healthlink Contracted [320179] | $67 - $73 | 207% |
| Imagine 360 Contracted [320494] | $67 | 207% |
| Municipal Health Plan Contracted [320271] | $67 | 207% |
| Reflect Health Contracted [320492] | $67 | 207% |
| Insurance System Inc Contracted [320465] | $73 | 225% |
| Personify Health Contracted [320051] | $73 | 225% |
| Preferred Health Plan Contracted [320522] | $73 | 225% |
| Workers Comp [20426] | $73 | 225% |
| Ppo Plus Contracted [320310] | $84 | 259% |
| First Health Contracted [320128] | $87 | 269% |
| Employers Health Coalition Contracted [320116] | $88 | 272% |
| Private Health Care Systems Contracted [320320] | $90 | 278% |
| Private Health Care Systems [20320] | $90 | 278% |
| Multiplan Contracted [320270] | $95 | 293% |
| Multiplan [20270] | $95 | 293% |
| Qual Choice Contracted [320324] | $104 | 321% |
| United Medical Resources Contracted [320454] | $186 | 574% |