CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Merit Health Madison

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $57
Cash Discount Price: $31
vs. Medicare Baseline: 1.76x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Merit Health Madison is $57. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.76x the Medicare baseline. Located in 161 River Oaks Drive, Canton, MS.

Cash / Self-Pay

$31

Average discount available for prompt cash payment at this facility.

Insurance Median

$57

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: $31 (96%)

Insurance Median: $57 (176%)

Cash: $31 (96% of Medicare)

Ins. Median: $57 (176% 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
Medicare (plans)	$30	93%
Devoted_Health	$31	96%
Humana	$31	96%
Wellcare	$31	96%
Advhealth	$35	108%
Blue Cross Blue Shield	$41	127%
Mpcn	$57	176%
Firstchoice	$60	185%
Molina_Exchange	$64	198%
Ambetter / Centene	$75	231%
Cigna	$77	238%
United	$77	238%
United_Exchange	$77	238%

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 $31.
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 Merit Health Madison 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.