CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Mercy Hospital Lebanon

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $142
Cash Discount Price: $121
vs. Medicare Baseline: 4.05x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Mercy Hospital Lebanon is $142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $121. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.05x the Medicare baseline. Located in 100 Hospital Drive, Lebanon, MO.

Cash / Self-Pay

$121

Average discount available for prompt cash payment at this facility.

Insurance Median

$142

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $121 (345%)

Insurance Median: $142 (405%)

Cash: $121 (345% of Medicare)

Ins. Median: $142 (405% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 405% of the Medicare baseline (a markup of 305%). 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	$28 - $56	80%
Aetna	$31 - $140	88%
Blue Cross Blue Shield	$31 - $492	88%
Centivo Contracted [320505]	$31	88%
Champva [20065]	$31	88%
Cherokee Nation Health Serv Contracted [320066]	$31	88%
Cigna	$31 - $138	88%
Cross Timbers Hospice [20098]	$31	88%
Dept Of Veteran Affairs Contracted [320106]	$31	88%
Elara Caring Aspire Hospice [20433]	$31	88%
Globalhealth Contracted [320145]	$31	88%
Halo Hcr Inc Hospice Contracted [320432]	$31	88%
Halo Hcr Inc Hospice [20432]	$31	88%
Humana	$31 - $158	88%
Kindful Hospice Contracted [320434]	$31	88%
Kindful Hospice [20434]	$31	88%
Medicare (plans)	$31 - $34	88%
Mercy Hospice Okc [20252]	$31	88%
Mercy Mgd Behavioral Health Contracted [320259]	$31	88%
Pace Of The Ozarks Contracted [320518]	$31	88%
Provider Partners Health Plans Contracted [320450]	$31	88%
Qual Choice Contracted [320325]	$31	88%
Tricare	$31	88%
UnitedHealthcare	$31 - $177	88%
Healthscope Contracted [320182]	$39	111%
Ambetter / Centene	$56	160%
Home State Health Plan Contracted [320187]	$56	160%
Novasys Contracted [320285]	$56	160%
Medica Contracted [320239]	$73	208%
Medica [20239]	$73	208%
Administrative Payor Contracted [320005]	$84	240%
Healthlink Contracted [320179]	$121 - $158	345%
Preferred Health Plan Contracted [320522]	$121	345%
90 Degree Benefits Contracted [320436]	$140	399%
Mercy Benefit Admin Contracted [320251]	$140 - $149	399%
Show-Me Health Administrators Contracted [320483]	$140	399%
United Medical Resources Contracted [320454]	$140 - $149	399%
Aither Health Contracted [320449]	$149	425%
Auxiant Contracted [320462]	$149	425%
Benefit Management Contracted [320052]	$149	425%
Ebms Contracted [320493]	$149	425%
Edison Health Solutions Contracted [320502]	$149	425%
Evolutions Health Care Contracted [320124]	$149	425%
First Health Contracted [320128]	$149	425%
Health Systems Inc Contracted [320174]	$149	425%
Imagine 360 Contracted [320494]	$149	425%
Insurance System Inc Contracted [320465]	$149	425%
Point C Contracted [320238]	$149 - $177	425%
Point C [20238]	$149	425%
Reflect Health Contracted [320492]	$149	425%
Workers Comp [20426]	$149 - $158	425%
Yuzu Health Contracted [320521]	$149	425%
American Healthcare Alliance Contracted [320020]	$158	451%
Usa Managed Care Org Contracted [320429]	$164	468%
Multiplan Contracted [320270]	$177	505%
Private Health Care Systems Contracted [320320]	$177	505%

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 $121.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

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 97530.
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.