CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: The Children's Mercy Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $97
Cash Discount Price: $72
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at The Children's Mercy Hospital is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.99x the Medicare baseline. Located in 2401 Gillham Road, Kansas City, MO.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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: $72 (222%)

Insurance Median: $97 (299%)

Cash: $72 (222% of Medicare)

Ins. Median: $97 (299% 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 299% of the Medicare baseline (a markup of 199%). 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
UnitedHealthcare	$20 - $100	62%
Healthy Blue	$22 - $86	68%
Medicaid / KanCare	$23	71%
Blue Cross Blue Shield	$61 - $110	188%
Cigna	$72 - $104	222%
Home State Health	$75	231%
Medica	$87	269%
Aetna	$89 - $101	275%
Centivo	$97	299%
Health Midwest Comprehensive Care	$97	299%
Nebraska Furniture Mart	$97	299%
Orscheln	$97	299%
Quiktrip	$97	299%
Wellfit/Centrus	$97	299%
Wppa Providrs Care	$97	299%
Humana	$99	306%
Coventry Health Care Of Kansas	$110	340%
Coxhealth Network	$110	340%
Mercy Health	$112	346%
Multiplan	$113	349%
American Healthcare Alliance	$127	392%
Healthlink	$131	404%
National Preferred Provider Network	$134	414%

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 $72.
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 The Children's Mercy Hospital 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.