CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Mercy Hospital Lebanon

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $115
Cash Discount Price: $98
vs. Medicare Baseline: 3.55x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital Lebanon is $115. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $98. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.55x the Medicare baseline. Located in 100 Hospital Drive, Lebanon, MO.

Cash / Self-Pay

$98

Average discount available for prompt cash payment at this facility.

Insurance Median

$115

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: $98 (302%)

Insurance Median: $115 (355%)

Cash: $98 (302% of Medicare)

Ins. Median: $115 (355% 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 355% of the Medicare baseline (a markup of 255%). 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
Medicaid / KanCare	$19 - $46	59%
Aetna	$29 - $112	90%
Blue Cross Blue Shield	$29 - $492	90%
Centivo Contracted [320505]	$29	90%
Champva [20065]	$29	90%
Cherokee Nation Health Serv Contracted [320066]	$29	90%
Cigna	$29 - $111	90%
Cross Timbers Hospice [20098]	$29	90%
Dept Of Veteran Affairs Contracted [320106]	$29	90%
Elara Caring Aspire Hospice [20433]	$29	90%
Globalhealth Contracted [320145]	$29	90%
Halo Hcr Inc Hospice Contracted [320432]	$29	90%
Halo Hcr Inc Hospice [20432]	$29	90%
Humana	$29 - $128	90%
Kindful Hospice Contracted [320434]	$29	90%
Kindful Hospice [20434]	$29	90%
Medicare (plans)	$29 - $32	90%
Mercy Hospice Okc [20252]	$29	90%
Mercy Mgd Behavioral Health Contracted [320259]	$29	90%
Pace Of The Ozarks Contracted [320518]	$29	90%
Provider Partners Health Plans Contracted [320450]	$29	90%
Qual Choice Contracted [320325]	$29	90%
Tricare	$29	90%
UnitedHealthcare	$29 - $142	90%
Healthscope Contracted [320182]	$36	111%
Ambetter / Centene	$45	139%
Home State Health Plan Contracted [320187]	$45	139%
Novasys Contracted [320285]	$45	139%
Medica Contracted [320239]	$59	182%
Medica [20239]	$59	182%
Administrative Payor Contracted [320005]	$68	210%
Healthlink Contracted [320179]	$98 - $128	302%
Preferred Health Plan Contracted [320522]	$98	302%
90 Degree Benefits Contracted [320436]	$112	346%
Mercy Benefit Admin Contracted [320251]	$112 - $120	346%
Show-Me Health Administrators Contracted [320483]	$112	346%
United Medical Resources Contracted [320454]	$112 - $120	346%
Aither Health Contracted [320449]	$120	370%
Auxiant Contracted [320462]	$120	370%
Benefit Management Contracted [320052]	$120	370%
Ebms Contracted [320493]	$120	370%
Edison Health Solutions Contracted [320502]	$120	370%
Evolutions Health Care Contracted [320124]	$120	370%
First Health Contracted [320128]	$120	370%
Health Systems Inc Contracted [320174]	$120	370%
Imagine 360 Contracted [320494]	$120	370%
Insurance System Inc Contracted [320465]	$120	370%
Point C Contracted [320238]	$120 - $142	370%
Point C [20238]	$120	370%
Reflect Health Contracted [320492]	$120	370%
Workers Comp [20426]	$120 - $128	370%
Yuzu Health Contracted [320521]	$120	370%
American Healthcare Alliance Contracted [320020]	$128	395%
Usa Managed Care Org Contracted [320429]	$132	407%
Multiplan Contracted [320270]	$142	438%
Private Health Care Systems Contracted [320320]	$142	438%

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 $98.
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 Lebanon 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.