CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Mercy Hospital Marietta

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $83
Cash Discount Price: $139
vs. Medicare Baseline: 2.56x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital Marietta is $83. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $139. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.56x the Medicare baseline. Located in 300 Wanda Street, Marietta, OK.

Cash / Self-Pay

$139

Average discount available for prompt cash payment at this facility.

Insurance Median

$83

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: $139 (429%)

Insurance Median: $83 (256%)

Cash: $139 (429% of Medicare)

Ins. Median: $83 (256% 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 256% of the Medicare baseline (a markup of 156%). 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
Aetna	$29 - $97	90%
Humana	$29 - $45	90%
Medicaid / KanCare	$29	90%
Blue Cross Blue Shield	$45 - $68	139%
Cross Timbers Hospice [20098]	$45	139%
Elara Caring Aspire Hospice Contracted [320433]	$45	139%
Elara Caring Aspire Hospice [20433]	$45	139%
Halo Hcr Inc Hospice Contracted [320432]	$45	139%
Halo Hcr Inc Hospice [20432]	$45	139%
Independent Health [20197]	$45	139%
Indian Health Service Contracted [320198]	$45	139%
Kindful Hospice Contracted [320434]	$45	139%
Kindful Hospice [20434]	$45	139%
Medical Associates Health [20444]	$45	139%
Medicare (plans)	$45 - $47	139%
Mercy Hospice Okc [20252]	$45	139%
UnitedHealthcare	$47 - $97	145%
Tricare	$48	148%
Cigna	$49 - $104	151%
Health Choice Contracted [320166]	$50	154%
Webtpa Contracted [320417]	$58	179%
Aither Health Contracted [320449]	$83 - $118	256%
Mercy Benefit Admin Contracted [320251]	$83 - $125	256%
Quik Trip Contracted [320447]	$83	256%
Show-Me Health Administrators Contracted [320483]	$83	256%
Osma Health Contracted [320292]	$97	299%
United Medical Resources Contracted [320454]	$97 - $125	299%
First Health Contracted [320128]	$98	302%
Benefit Management Contracted [320052]	$104 - $125	321%
Healthcare Highways Plus Contracted [320175]	$104	321%
Auxiant Contracted [320462]	$118 - $125	364%
Ebms Contracted [320493]	$118	364%
Healthlink Contracted [320179]	$118 - $125	364%
Preferred Community Choice Contracted [320311]	$118	364%
Federal Medical Center Contracted [320127]	$125	386%
Healthscope Contracted [320182]	$125	386%
Point C Contracted [320238]	$125	386%
Preferred Health Plan Contracted [320522]	$125	386%
Tri State Healthcare Coalition Contracted [320379]	$125	386%

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 $139.
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 Marietta 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.