CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Mercy Hospital Springfield
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $105
- Cash Discount Price: $121
- vs. Medicare Baseline: 3.24x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital Springfield is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $121. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.24x the Medicare baseline. Located in 2115 S. Fremont Ave, Springfield, MO.
Cash / Self-Pay
$121
Average discount available for prompt cash payment at this facility.
Insurance Median
$105
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: $121 (373%)
Insurance Median: $105 (324%)
Cash: $121 (373% of Medicare)
Ins. Median: $105 (324% 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 324% of the Medicare baseline (a markup of 224%). 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 |
|---|---|---|
| Blue Cross Blue Shield | $19 - $261 | 59% |
| Medicaid / KanCare | $19 - $77 | 59% |
| Aetna | $29 - $62 | 90% |
| Centivo Contracted [320505] | $29 | 90% |
| Centurion Of Missouri [20459] | $29 | 90% |
| Champva [20065] | $29 | 90% |
| Cherokee Nation Health Serv Contracted [320066] | $29 | 90% |
| Cigna | $29 - $145 | 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% |
| Humana | $29 - $128 | 90% |
| Indian Health Service Contracted [320198] | $29 | 90% |
| Indian Health Service [20198] | $29 | 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% |
| Mercy Rehab Hospital Contracted [320260] | $29 | 90% |
| Pace Of The Ozarks Contracted [320518] | $29 | 90% |
| Qual Choice Contracted [320325] | $29 | 90% |
| Tricare | $29 | 90% |
| UnitedHealthcare | $29 - $487 | 90% |
| Provider Partners Health Plans Contracted [320450] | $32 | 99% |
| Healthscope Contracted [320182] | $36 | 111% |
| Providrs Care Network Contracted [320484] | $57 | 176% |
| Medica Contracted [320239] | $73 - $74 | 225% |
| Medica [20239] | $73 - $74 | 225% |
| Benefit Management Contracted [320052] | $74 - $75 | 228% |
| Health Systems Inc Contracted [320174] | $74 - $75 | 228% |
| Insurance System Inc Contracted [320465] | $74 - $75 | 228% |
| Ambetter / Centene | $75 - $77 | 231% |
| Home State Health Plan Contracted [320187] | $75 - $77 | 231% |
| Novasys Contracted [320285] | $75 - $77 | 231% |
| Administrative Payor Contracted [320005] | $83 - $94 | 256% |
| Evolutions Health Care Contracted [320124] | $83 - $85 | 256% |
| Point C Contracted [320238] | $83 - $141 | 256% |
| Point C [20238] | $83 - $85 | 256% |
| Medical Destinations Contracted [320242] | $92 - $94 | 284% |
| Mercy Benefit Admin Contracted [320251] | $92 - $195 | 284% |
| Workers Comp [20426] | $92 - $160 | 284% |
| United Medical Resources Contracted [320454] | $96 - $315 | 296% |
| First Health Contracted [320128] | $103 - $105 | 318% |
| Aither Health Contracted [320449] | $105 - $107 | 324% |
| Auxiant Contracted [320462] | $105 - $122 | 324% |
| Ebms Contracted [320493] | $105 - $107 | 324% |
| Edison Health Solutions Contracted [320502] | $105 - $107 | 324% |
| Healthlink Contracted [320179] | $105 - $150 | 324% |
| Imagine 360 Contracted [320494] | $105 - $107 | 324% |
| Reflect Health Contracted [320492] | $105 - $107 | 324% |
| Yuzu Health Contracted [320521] | $105 - $107 | 324% |
| Federal Medical Center Contracted [320127] | $110 - $113 | 340% |
| Show-Me Health Administrators Contracted [320483] | $110 - $195 | 340% |
| 90 Degree Benefits Contracted [320436] | $113 - $195 | 349% |
| Multiplan Contracted [320270] | $142 - $145 | 438% |
| Private Health Care Systems Contracted [320320] | $142 - $145 | 438% |
| Compcare Of The Ozarks Contracted [320437] | $145 - $149 | 448% |
| American Healthcare Alliance Contracted [320020] | $147 - $150 | 454% |
| Qual Choice Contracted [320324] | $147 - $150 | 454% |
| Municipal Health Plan Contracted [320271] | $149 - $152 | 460% |
| Usa Managed Care Org Contracted [320429] | $162 - $165 | 500% |
| Ppo Plus Contracted [320310] | $166 - $169 | 512% |