CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Mercy Hospital Joplin

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $87
Cash Discount Price: $128
vs. Medicare Baseline: 2.69x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital Joplin is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $128. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.69x the Medicare baseline. Located in 100 Mercy Way, Joplin, MO.

Cash / Self-Pay

$128

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $128 (395%)

Insurance Median: $87 (269%)

Cash: $128 (395% of Medicare)

Ins. Median: $87 (269% 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 269% of the Medicare baseline (a markup of 169%). 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	$19 - $197	59%
Medicaid / KanCare	$19 - $55	59%
Humana	$28 - $59	86%
Aetna	$29 - $50	90%
Centivo Contracted [320505]	$29	90%
Champva [20065]	$29	90%
Cherokee Nation Health Serv Contracted [320066]	$29	90%
Cigna	$29 - $152	90%
Cross Timbers Hospice [20098]	$29	90%
Dept Of Veteran Affairs Contracted [320106]	$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%
Indian Health Service Contracted [320198]	$29 - $128	90%
Kindful Hospice Contracted [320434]	$29	90%
Kindful Hospice [20434]	$29	90%
Medicare (plans)	$29 - $32	90%
Mercy Hospice Okc [20252]	$29	90%
Mercy Mgd Behavioral Health Contracted [320259]	$29	90%
Pace Of The Ozarks Contracted [320518]	$29	90%
Provider Partners Health Plans Contracted [320450]	$29	90%
Qual Choice Contracted [320325]	$29	90%
Tricare	$29	90%
UnitedHealthcare	$29 - $81	90%
Healthscope Contracted [320182]	$36	111%
Workers Comp [20426]	$40 - $167	123%
Health Choice Contracted [320166]	$46	142%
Ambetter / Centene	$55	170%
Home State Health Plan Contracted [320187]	$55	170%
Novasys Contracted [320285]	$55	170%
Providrs Care Network Contracted [320484]	$57	176%
Point C Contracted [320238]	$69 - $158	213%
Medica Contracted [320239]	$72	222%
United Medical Resources Contracted [320454]	$77 - $81	238%
Benefit Management Contracted [320052]	$85	262%
Health Systems Inc Contracted [320174]	$85	262%
Insurance System Inc Contracted [320465]	$85	262%
Administrative Payor Contracted [320005]	$89	275%
Mercy Benefit Admin Contracted [320251]	$98 - $195	302%
Aither Health Contracted [320449]	$112	346%
Auxiant Contracted [320462]	$112 - $128	346%
Ebms Contracted [320493]	$112	346%
Edison Health Solutions Contracted [320502]	$112	346%
Healthlink Contracted [320179]	$112 - $158	346%
Imagine 360 Contracted [320494]	$112	346%
Reflect Health Contracted [320492]	$112	346%
Yuzu Health Contracted [320521]	$112	346%
Show-Me Health Administrators Contracted [320483]	$118 - $195	364%
Preferred Health Plan Contracted [320522]	$128	395%
First Health Contracted [320128]	$134	414%
American Healthcare Alliance Contracted [320020]	$138	426%
Multiplan Contracted [320270]	$152	469%
Private Health Care Systems Contracted [320320]	$152	469%
Usable Contracted [320409]	$152	469%
Point C [20238]	$158	488%
Usa Managed Care Org Contracted [320429]	$173	534%
Ppo Plus Contracted [320310]	$177	546%
90 Degree Benefits Contracted [320436]	$195	602%

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 $128.
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 Mercy Hospital Joplin 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.