CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Mercy Hospital Oklahoma City, Inc
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $92
- Cash Discount Price: $142
- vs. Medicare Baseline: 2.84x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital Oklahoma City, Inc is $92. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $142. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.84x the Medicare baseline. Located in 4300 West Memorial Road, Oklahoma City, OK.
Cash / Self-Pay
$142
Average discount available for prompt cash payment at this facility.
Insurance Median
$92
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: $142 (438%)
Insurance Median: $92 (284%)
Cash: $142 (438% of Medicare)
Ins. Median: $92 (284% 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 284% of the Medicare baseline (a markup of 184%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Tricare | $28 - $30 | 86% |
| Aetna | $29 - $214 | 90% |
| Humana | $29 - $204 | 90% |
| Medicaid / KanCare | $29 - $41 | 90% |
| Blue Cross Blue Shield | $30 | 93% |
| Champva [20065] | $30 | 93% |
| Cherokee Nation Health Serv Contracted [320066] | $30 | 93% |
| Cigna | $30 - $177 | 93% |
| Cross Timbers Hospice [20098] | $30 | 93% |
| Dept Of Veteran Affairs Contracted [320106] | $30 | 93% |
| Elara Caring Aspire Hospice Contracted [320433] | $30 | 93% |
| Elara Caring Aspire Hospice [20433] | $30 | 93% |
| Globalhealth Contracted [320145] | $30 | 93% |
| Halo Hcr Inc Hospice Contracted [320432] | $30 | 93% |
| Halo Hcr Inc Hospice [20432] | $30 | 93% |
| Indian Health Service Contracted [320198] | $30 | 93% |
| Kindful Hospice Contracted [320434] | $30 | 93% |
| Kindful Hospice [20434] | $30 | 93% |
| Longevity Health Plan [10477] | $30 | 93% |
| Medicare (plans) | $30 - $32 | 93% |
| Mercy Hospice Okc [20252] | $30 | 93% |
| Mercy Rehab Hospital Contracted [320260] | $30 | 93% |
| Provider Partners Health Plans Contracted [320450] | $30 | 93% |
| Qual Choice Contracted [320325] | $30 | 93% |
| UnitedHealthcare | $30 - $144 | 93% |
| Amg Spec Hosp Edmond [20034] | $32 | 99% |
| Ambetter / Centene | $41 | 127% |
| Home State Health Plan Contracted [320187] | $41 | 127% |
| Novasys Contracted [320285] | $41 | 127% |
| Workers Comp [20426] | $43 | 133% |
| Community Care Contracted [320080] | $45 - $207 | 139% |
| Medica Contracted [320239] | $45 - $94 | 139% |
| Health Choice Contracted [320166] | $46 | 142% |
| Healthcare Highways Plus Contracted [320175] | $55 - $178 | 170% |
| Webtpa Contracted [320417] | $59 - $124 | 182% |
| Osma Health Contracted [320292] | $63 - $133 | 194% |
| Healthsmart Preferred Care Contracted [320184] | $67 - $192 | 207% |
| Kempton Contracted [320214] | $67 | 207% |
| Aither Health Contracted [320449] | $85 - $178 | 262% |
| Auxiant Contracted [320462] | $85 - $192 | 262% |
| Benefit Management Contracted [320052] | $85 - $192 | 262% |
| Ebms Contracted [320493] | $85 - $178 | 262% |
| Healthlink Contracted [320179] | $85 - $192 | 262% |
| Imagine 360 Contracted [320494] | $85 - $178 | 262% |
| Mercy Benefit Admin Contracted [320251] | $85 - $192 | 262% |
| Quik Trip Contracted [320447] | $85 - $178 | 262% |
| Reflect Health Contracted [320492] | $85 - $178 | 262% |
| Show-Me Health Administrators Contracted [320483] | $85 - $178 | 262% |
| Yuzu Health Contracted [320521] | $85 - $178 | 262% |
| First Health Contracted [320128] | $87 - $182 | 269% |
| Federal Medical Center Contracted [320127] | $92 - $192 | 284% |
| Healthscope Contracted [320182] | $92 - $192 | 284% |
| Healthsmart Accel Contracted [320183] | $92 - $192 | 284% |
| Point C Contracted [320238] | $92 - $192 | 284% |
| Preferred Health Plan Contracted [320522] | $92 - $192 | 284% |
| Private Health Care Systems Contracted [320320] | $92 - $207 | 284% |
| Tri State Healthcare Coalition Contracted [320379] | $92 - $192 | 284% |
| United Medical Resources Contracted [320454] | $92 - $192 | 284% |
| Multiplan Contracted [320270] | $99 - $266 | 306% |
| Globalhealth Contracted [320144] | $100 - $210 | 309% |
| Preferred Community Choice Contracted [320311] | $107 - $225 | 330% |
| Centralink Contracted [320480] | $141 - $296 | 435% |