CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Mercy Hospital South
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $56
- Cash Discount Price: $48
- vs. Medicare Baseline: 1.73x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital South is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $48. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.73x the Medicare baseline. Located in 10010 Kennerly Road, Saint Louis, MO.
Cash / Self-Pay
$48
Average discount available for prompt cash payment at this facility.
Insurance Median
$56
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: $48 (148%)
Insurance Median: $56 (173%)
Cash: $48 (148% of Medicare)
Ins. Median: $56 (173% 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 |
|---|---|---|
| Medicaid / KanCare | $5 - $145 | 15% |
| Aetna | $11 - $184 | 34% |
| American Health Advantage Of Mo Mcr [10473] | $31 | 96% |
| Blue Cross Blue Shield | $31 - $233 | 96% |
| Cherokee Nation Health Serv Contracted [320066] | $31 | 96% |
| Cigna | $31 - $233 | 96% |
| Cross Timbers Hospice [20098] | $31 | 96% |
| Dept Of Veteran Affairs Contracted [320106] | $31 | 96% |
| Elara Caring Aspire Hospice Contracted [320433] | $31 | 96% |
| Elara Caring Aspire Hospice [20433] | $31 | 96% |
| Globalhealth Contracted [320145] | $31 | 96% |
| Halo Hcr Inc Hospice Contracted [320432] | $31 | 96% |
| Halo Hcr Inc Hospice [20432] | $31 | 96% |
| Humana | $31 - $53 | 96% |
| Kindful Hospice Contracted [320434] | $31 | 96% |
| Kindful Hospice [20434] | $31 | 96% |
| Medicare (plans) | $31 - $74 | 96% |
| Mercy Hospice Okc [20252] | $31 | 96% |
| Pace Of The Ozarks Contracted [320518] | $31 | 96% |
| Qual Choice Contracted [320325] | $31 | 96% |
| Tricare | $31 | 96% |
| UnitedHealthcare | $31 - $193 | 96% |
| Provider Partners Health Plans Contracted [320450] | $34 | 105% |
| St Johns Mercy Rehab Llc Contracted [320359] | $34 | 105% |
| Health Choices Contracted [320448] | $44 | 136% |
| Health Choices [20448] | $44 | 136% |
| Medical Associates Health Contracted [320444] | $44 | 136% |
| Federal Medical Center Contracted [320127] | $48 | 148% |
| Insurance System Inc Contracted [320465] | $48 | 148% |
| Point C Contracted [320238] | $48 | 148% |
| Tri State Healthcare Coalition Contracted [320379] | $48 | 148% |
| Healthlink Contracted [320179] | $50 - $225 | 154% |
| Centivo Contracted [320505] | $51 | 157% |
| First Health Contracted [320128] | $52 - $53 | 160% |
| Mercy Mgd Behavioral Health Contracted [320259] | $52 | 160% |
| Multiplan Contracted [320270] | $52 - $56 | 160% |
| Private Health Care Systems Contracted [320320] | $52 | 160% |
| Preferred Health Plan Contracted [320522] | $55 | 170% |
| Workers Comp [20426] | $56 - $59 | 173% |
| Hope Trust Contracted [320488] | $70 | 216% |
| Medica Contracted [320239] | $137 | 423% |
| Ambetter / Centene | $145 | 448% |
| Home State Health Plan Contracted [320187] | $145 | 448% |
| Novasys Contracted [320285] | $145 | 448% |
| Mercy Benefit Admin Contracted [320251] | $170 - $215 | 525% |
| Mercy Benefit Admin [20251] | $170 - $215 | 525% |
| United Medical Resources Contracted [320454] | $193 | 596% |
| Show-Me Health Administrators Contracted [320483] | $209 - $219 | 645% |
| Aither Health Contracted [320449] | $215 | 664% |
| Aither Health [20449] | $215 | 664% |
| Auxiant Contracted [320462] | $215 | 664% |
| Ebms Contracted [320493] | $215 | 664% |
| Edison Health Solutions Contracted [320502] | $215 | 664% |
| Imagine 360 Contracted [320494] | $215 | 664% |
| Reflect Health Contracted [320492] | $215 | 664% |
| Yuzu Health Contracted [320521] | $215 | 664% |