CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Mercy Hospital Southeast

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $37
Cash Discount Price: $124
vs. Medicare Baseline: 1.14x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital Southeast is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $124. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.14x the Medicare baseline. Located in 1701 Lacey St, Cape Girardeau, MO.

Cash / Self-Pay

$124

Average discount available for prompt cash payment at this facility.

Insurance Median

$37

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: $124 (383%)

Insurance Median: $37 (114%)

Cash: $124 (383% of Medicare)

Ins. Median: $37 (114% 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.

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
Aetna	$12 - $122	37%
Medicaid / KanCare	$12 - $51	37%
Auxiant Contracted [320462]	$29 - $58	90%
Blue Cross Blue Shield	$29 - $180	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%
Halo Hcr Inc Hospice Contracted [320432]	$29	90%
Halo Hcr Inc Hospice [20432]	$29	90%
Healthlink Contracted [320179]	$29 - $152	90%
Humana	$29 - $162	90%
Imagine 360 Contracted [320494]	$29	90%
Kindful Hospice Contracted [320434]	$29	90%
Kindful Hospice [20434]	$29	90%
Medicare (plans)	$29 - $30	90%
Mercy Benefit Admin Contracted [320251]	$29 - $129	90%
Mercy Hospice Okc [20252]	$29	90%
Pace Of The Ozarks Contracted [320518]	$29	90%
Tricare	$29	90%
Ambetter / Centene	$30	93%
American Health Advantage Of Mo Mcr Hmo Contracted [320264]	$30	93%
Home State Health Plan Contracted [320187]	$30	93%
Hope Trust Contracted [320488]	$30	93%
UnitedHealthcare	$30 - $44	93%
Provider Partners Health Plans Contracted [320450]	$33	102%
United Medical Resources Contracted [320454]	$33	102%
Consociate Consolidated Health Contracted [320490]	$41 - $65	127%
Centivo Contracted [320505]	$49	151%
Ebms Contracted [320493]	$49	151%
Preferred Health Plan Contracted [320522]	$52	160%
Reflect Health Contracted [320492]	$53	164%
First Health Contracted [320128]	$122	377%
Health Alliance Contracted [320164]	$124	383%
Aither Health Contracted [320449]	$129	398%
Edison Health Solutions Contracted [320502]	$129	398%
Mercy Benefit Admin [20251]	$129	398%
Yuzu Health Contracted [320521]	$129	398%
Workers Comp [20426]	$142 - $152	438%
Multiplan Contracted [320270]	$152	469%
Private Health Care Systems Contracted [320320]	$152	469%
Cigna	$286	883%

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 $124.
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 Southeast 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.