CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Mercy Hospital Carthage

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $79
Cash Discount Price: $79
vs. Medicare Baseline: 2.44x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital Carthage is $79. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $79. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.44x the Medicare baseline. Located in 3125 Dr Russell Smith Way, Carthage, MO.

Cash / Self-Pay

$79

Average discount available for prompt cash payment at this facility.

Insurance Median

$79

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: $79 (244%)

Insurance Median: $79 (244%)

Cash: $79 (244% of Medicare)

Ins. Median: $79 (244% 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 244% of the Medicare baseline (a markup of 144%). 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 - $185	59%
Medicaid / KanCare	$19 - $66	59%
Aetna	$29 - $108	90%
Humana	$29 - $36	90%
Medicare (plans)	$31 - $36	96%
Cherokee Nation Health Serv Contracted [320066]	$33	102%
Cigna	$33 - $109	102%
Cross Timbers Hospice [20098]	$33	102%
Dept Of Veteran Affairs Contracted [320106]	$33	102%
Elara Caring Aspire Hospice [20433]	$33	102%
Globalhealth Contracted [320145]	$33	102%
Halo Hcr Inc Hospice Contracted [320432]	$33	102%
Halo Hcr Inc Hospice [20432]	$33	102%
Indian Health Service Contracted [320198]	$33	102%
Kindful Hospice Contracted [320434]	$33	102%
Kindful Hospice [20434]	$33	102%
Medical Associates Health Contracted [320444]	$33	102%
Mercy Hospice Okc [20252]	$33	102%
Mercy Mgd Behavioral Health Contracted [320259]	$33	102%
Pace Of The Ozarks Contracted [320518]	$33	102%
Provider Partners Health Plans Contracted [320450]	$33	102%
Qual Choice Contracted [320325]	$33	102%
Tricare	$33	102%
UnitedHealthcare	$33 - $105	102%
Workers Comp [20426]	$40 - $109	123%
Point C Contracted [320238]	$42 - $109	130%
Health Systems Inc Contracted [320174]	$52	160%
Insurance System Inc Contracted [320465]	$52	160%
Administrative Payor Contracted [320005]	$54	167%
Centivo Contracted [320505]	$56	173%
Healthscope Contracted [320182]	$63	194%
Ambetter / Centene	$66	204%
Home State Health Plan Contracted [320187]	$66	204%
Novasys Contracted [320285]	$66	204%
Benefit Management Contracted [320052]	$73 - $105	225%
Auxiant Contracted [320462]	$79 - $103	244%
Healthlink Contracted [320179]	$79 - $113	244%
Preferred Health Plan Contracted [320522]	$79	244%
United Medical Resources Contracted [320454]	$100 - $109	309%
90 Degree Benefits Contracted [320436]	$103	318%
Aither Health Contracted [320449]	$103	318%
Ebms Contracted [320493]	$103	318%
Edison Health Solutions Contracted [320502]	$103	318%
Imagine 360 Contracted [320494]	$103	318%
Mercy Benefit Admin Contracted [320251]	$103 - $109	318%
Reflect Health Contracted [320492]	$103	318%
Show-Me Health Administrators Contracted [320483]	$103	318%
Yuzu Health Contracted [320521]	$103	318%
Evolutions Health Care Contracted [320124]	$105	324%
First Health Contracted [320128]	$105	324%
Medica Contracted [320239]	$105	324%
Multiplan Contracted [320270]	$105	324%
Private Health Care Systems Contracted [320320]	$105	324%
American Healthcare Alliance Contracted [320020]	$109	336%
Ppo Plus Contracted [320310]	$109	336%
Usa Managed Care Org Contracted [320429]	$109	336%

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 $79.
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 Carthage 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.