CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Mercy Hospital of Buffalo

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $32
Cash Discount Price: $88
vs. Medicare Baseline: 0.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital of Buffalo is $32. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $88. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.99x the Medicare baseline. Located in 565 Abbott Road, Buffalo, NY.

Cash / Self-Pay

$88

Average discount available for prompt cash payment at this facility.

Insurance Median

$32

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: $88 (272%)

Insurance Median: $32 (99%)

Cash: $88 (272% of Medicare)

Ins. Median: $32 (99% 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
UnitedHealthcare	$16 - $37	49%
Medicaid / KanCare	$22 - $34	68%
Independent Health Essential [100166]	$22 - $41	68%
Blue Cross Blue Shield	$26 - $48	80%
Univera Healthcare [100169]	$27 - $36	83%
Univera Healthcare Essential [100170]	$27	83%
Beacon Essential [350122]	$28 - $38	86%
Fidelis Essential [100163]	$28 - $38	86%
VA Veterans Affairs [700001]	$28 - $32	86%
Federal Workers Compensation [500100]	$28	86%
No Fault [114001]	$28	86%
UPMC Health Plan [100181]	$29 - $57	90%
Medicare (plans)	$31 - $67	96%
Magnacare [100142]	$32	99%
Meritain [100063]	$32	99%
Champ VA [700002]	$32	99%
Covid19 Hrsa [45013]	$32	99%
Tricare	$32	99%
Aetna	$32 - $33	99%
Cigna	$32 - $46	99%
Catholic Health Life Pace [400005]	$32	99%
Seneca Nation [450119]	$32	99%
Humana	$32	99%
Fallon Health [450115]	$32	99%
Hospice [550001]	$32	99%
Fidelis Dual Advantage [450120]	$33	102%
Wellcare Fidelis Dual [450451]	$33	102%
Ghi [100153]	$35	108%
Wellcare [450129]	$35	108%
Independent Health [100165]	$36 - $82	111%
Iha First Choice [800001]	$36 - $74	111%
Beacon Health Options [100023]	$38	117%
Fidelis Exchange [100164]	$38	117%
Mvp Healthcare [100168]	$42	130%

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 $88.
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 of Buffalo 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.