CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Mercy Health Lakeshore Campus
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $115
- Cash Discount Price: $87
- vs. Medicare Baseline: 3.55x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Health Lakeshore Campus is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $87. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.55x the Medicare baseline. Located in 72 South State Street, Shelby, MI.
Cash / Self-Pay
$87
Average discount available for prompt cash payment at this facility.
Insurance Median
$115
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: $87 (269%)
Insurance Median: $115 (355%)
Cash: $87 (269% of Medicare)
Ins. Median: $115 (355% 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 355% of the Medicare baseline (a markup of 255%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Access Health | $23 | 71% |
| Blue Cross Blue Shield | $23 - $115 | 71% |
| Medicaid / KanCare | $23 | 71% |
| Blue Care Network Advantage | $33 | 102% |
| Medicare (plans) | $33 | 102% |
| Aetna | $34 - $107 | 105% |
| Align Senior Care | $34 | 105% |
| Correctional Recovery | $34 | 105% |
| Longevity Ipa Of Michigan Llc Health Plan Isnp | $38 | 117% |
| Oscar | $41 | 127% |
| Vitalcore | $45 | 139% |
| UnitedHealthcare | $47 - $121 | 145% |
| Wellpath | $48 | 148% |
| U Of M Health Plan | $49 - $120 | 151% |
| Molina Marketplace | $56 | 173% |
| Hospice Of Michigan | $74 | 228% |
| Nomi Health | $75 | 231% |
| Hap | $100 - $123 | 309% |
| Wc Accident Fund | $106 | 327% |
| Wc Advantage | $106 | 327% |
| Wc Aig | $106 | 327% |
| Wc Allied | $106 | 327% |
| Wc Amerisure | $106 | 327% |
| Wc Amtrust | $106 | 327% |
| Wc Asu Risk Mgt | $106 | 327% |
| Wc Berkley Admin | $106 | 327% |
| Wc Broadspire | $106 | 327% |
| Wc Bunch & Associates | $106 | 327% |
| Wc Ccmsi | $106 | 327% |
| Wc Emc Insurance Company | $106 | 327% |
| Wc Esis | $106 | 327% |
| Wc Fcci | $106 | 327% |
| Wc Federated | $106 | 327% |
| Wc Gallagher Bassett | $106 | 327% |
| Wc Genex Care For Ohio | $106 | 327% |
| Wc Guard Insurance Company | $106 | 327% |
| Wc Hartford | $106 | 327% |
| Wc Liberty Mutual | $106 | 327% |
| Wc Meijers | $106 | 327% |
| Wc Michigan | $106 | 327% |
| Wc Mitchell Frankenmuth | $106 | 327% |
| Wc Pma | $106 | 327% |
| Wc Sedgwick | $106 | 327% |
| Wc Sentry | $106 | 327% |
| Wc Travelers | $106 | 327% |
| Wc Tristar | $106 | 327% |
| Wc Walmart | $106 | 327% |
| Wc Zurich | $106 | 327% |
| Geha | $107 - $121 | 330% |
| Meritain | $107 | 330% |
| Asr Health Benefits | $112 | 346% |
| 1199 National Benefit Fund | $115 | 355% |
| Allied National Global Care | $115 | 355% |
| Asrm - Reliance Standard Life Insurance | $115 | 355% |
| Bcn Domestic | $115 | 355% |
| Blue Benefit Administrators Of Massachusetts | $115 | 355% |
| Blue Care Network | $115 | 355% |
| Blue Distinction Transplant | $115 | 355% |
| Blue Shield - Ca | $115 | 355% |
| Blue Shield - Id (Regence) | $115 | 355% |
| Blue Shield - Ny Highmark Northeastern | $115 | 355% |
| Blue Shield - Ny Highmark Western | $115 | 355% |
| Blue Shield - Pa (Highmark) | $115 | 355% |
| Blue Shield - Wa (Regence) | $115 | 355% |
| Christian Care Ministry | $115 | 355% |
| Dean Health | $115 | 355% |
| Fallon Health | $115 | 355% |
| Family Life Insurance Company | $115 | 355% |
| Ghc Scw | $115 | 355% |
| Group Pension Administrators | $115 | 355% |
| Health Choices | $115 - $120 | 355% |
| International Benefit Administrators | $115 | 355% |
| Kaiser Domestic | $115 | 355% |
| Lifetime Benefit Solutions | $115 | 355% |
| Manhattan Life | $115 | 355% |
| Medi Share | $115 | 355% |
| Multiplan | $115 | 355% |
| Mvp | $115 | 355% |
| Pai | $115 | 355% |
| Pan-American Life | $115 | 355% |
| Paramount Hmo | $115 | 355% |
| Phcs | $115 | 355% |
| Trinity Health Share | $115 | 355% |
| Cigna | $116 | 358% |
| Acclaim | $120 | 370% |
| Administrative Concepts | $120 | 370% |
| Allegeant | $120 | 370% |
| Allied Benefit Systems | $120 | 370% |
| Ameriben | $120 | 370% |
| American Family | $120 | 370% |
| American Healthcare Alliance | $120 | 370% |
| American Republic | $120 | 370% |
| Amerihealth | $120 | 370% |
| Aultcare | $120 | 370% |
| Automated Benefit Services | $120 | 370% |
| Auxiant | $120 | 370% |
| Benefit Administrative Systems,Llc | $120 | 370% |
| Boon Chapman | $120 | 370% |
| Cam Administrative Services | $120 | 370% |
| Caresource | $120 | 370% |
| Christian Brother Services | $120 | 370% |
| Christian Brothers Holy Cross | $120 | 370% |
| Claimchoice Adminstrators | $120 | 370% |
| Comprehensive Benefits | $120 | 370% |
| Consociate | $120 | 370% |
| Continental Life Insurance | $120 | 370% |
| Custom Benefit Administrators | $120 | 370% |
| Cypress Benefit Administrators | $120 | 370% |
| Employee Benefit Concepts | $120 | 370% |
| Employee Benefit Management | $120 | 370% |
| Enterprise Group Planning | $120 | 370% |
| Forest County Potawatomi | $120 | 370% |
| Freedom Life Insurance Company | $120 | 370% |
| Group Administrators | $120 | 370% |
| Group Marketing Services | $120 | 370% |
| Guardian | $120 | 370% |
| Health America | $120 | 370% |
| Health Smart | $120 | 370% |
| Healthez | $120 | 370% |
| Healthgram | $120 | 370% |
| Healthscope | $120 | 370% |
| Humana | $120 | 370% |
| Insight | $120 | 370% |
| Intercare | $120 | 370% |
| Jfp Benefit Management | $120 | 370% |
| Jp Farley Corporation | $120 | 370% |
| Key Benefit Administrator | $120 | 370% |
| Liberty Union Life Assurance Co | $120 | 370% |
| Lucent Health | $120 | 370% |
| Luminare Health | $120 | 370% |
| Luminare Health (Detroit) | $120 | 370% |
| Medben | $120 | 370% |
| Medcost | $120 | 370% |
| Medical Mutual | $120 | 370% |
| Mutual Health Services | $120 | 370% |
| Mutual Of Omaha | $120 | 370% |
| Ncas | $120 | 370% |
| Nippon Life Ins | $120 | 370% |
| Nova | $120 | 370% |
| Painters Union Insurance Fund | $120 | 370% |
| Physicians Mutual | $120 | 370% |
| Plumbers Local 98 Insurance Fund | $120 | 370% |
| Prairie States | $120 | 370% |
| Primary Physician Care | $120 | 370% |
| Professional Benefit Administrators | $120 | 370% |
| Secureone Preferred United Plans | $120 | 370% |
| The Loomis Company | $120 | 370% |
| Trustmark Small Business Benefits | $120 | 370% |
| Unicare | $120 | 370% |
| Unified Group Services | $120 | 370% |
| Us Health And Life | $120 | 370% |
| Valenz | $120 | 370% |
| Varipro | $120 - $123 | 370% |
| Western & Southern Financial Group | $120 | 370% |
| Wps | $120 | 370% |
| First Health | $121 | 373% |
| Priority Health | $121 | 373% |