CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Mercy Hospital Lincoln

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $104
Cash Discount Price: $90
vs. Medicare Baseline: 3.21x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mercy Hospital Lincoln is $104. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $90. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.21x the Medicare baseline. Located in 1000 East Cherry Street, Troy, MO.

Cash / Self-Pay

$90

Average discount available for prompt cash payment at this facility.

Insurance Median

$104

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: $90 (278%)

Insurance Median: $104 (321%)

Cash: $90 (278% of Medicare)

Ins. Median: $104 (321% 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 321% of the Medicare baseline (a markup of 221%). 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	$9 - $64	28%
Aetna	$21 - $91	65%
Medicare (plans)	$30 - $139	93%
Tricare	$30	93%
UnitedHealthcare	$31 - $92	96%
American Health Advantage Of Mo Mcr [10473]	$33	102%
Blue Cross Blue Shield	$33 - $202	102%
Cherokee Nation Health Serv Contracted [320066]	$33	102%
Cross Timbers Hospice [20098]	$33	102%
Dept Of Veteran Affairs Contracted [320106]	$33	102%
Elara Caring Aspire Hospice Contracted [320433]	$33	102%
Elara Caring Aspire Hospice [20433]	$33	102%
Globalhealth Contracted [320145]	$33	102%
Halo Hcr Inc Hospice Contracted [320432]	$33	102%
Halo Hcr Inc Hospice [20432]	$33	102%
Humana	$33 - $125	102%
Indian Health Service Contracted [320198]	$33	102%
Kindful Hospice Contracted [320434]	$33	102%
Kindful Hospice [20434]	$33	102%
Mercy Hospice Okc [20252]	$33	102%
Pace Of The Ozarks Contracted [320518]	$33	102%
Provider Partners Health Plans Contracted [320450]	$33	102%
Qual Choice Contracted [320325]	$33	102%
Cigna	$35 - $115	108%
Centivo Contracted [320505]	$50	154%
Medica Contracted [320239]	$58	179%
Ambetter / Centene	$64	198%
Home State Health Plan Contracted [320187]	$64	198%
Novasys Contracted [320285]	$64	198%
Hope Trust Contracted [320488]	$69	213%
Health Choices Contracted [320448]	$83	256%
Health Choices [20448]	$83	256%
Medical Associates Health Contracted [320444]	$83	256%
First Health Contracted [320128]	$91 - $104	281%
United Medical Resources Contracted [320454]	$92	284%
Mercy Mgd Behavioral Health Contracted [320259]	$104	321%
Multiplan Contracted [320270]	$104	321%
Private Health Care Systems Contracted [320320]	$104	321%
Workers Comp [20426]	$104 - $111	321%
Healthlink Contracted [320179]	$113 - $124	349%
Aither Health Contracted [320449]	$118	364%
Aither Health [20449]	$118	364%
Auxiant Contracted [320462]	$118	364%
Ebms Contracted [320493]	$118	364%
Edison Health Solutions Contracted [320502]	$118	364%
Federal Medical Center Contracted [320127]	$118	364%
Imagine 360 Contracted [320494]	$118	364%
Insurance System Inc Contracted [320465]	$118	364%
Mercy Benefit Admin Contracted [320251]	$118	364%
Mercy Benefit Admin [20251]	$118	364%
Point C Contracted [320238]	$118	364%
Preferred Health Plan Contracted [320522]	$118	364%
Reflect Health Contracted [320492]	$118	364%
Show-Me Health Administrators Contracted [320483]	$118	364%
Tri State Healthcare Coalition Contracted [320379]	$118	364%
Yuzu Health Contracted [320521]	$118	364%

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 $90.
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 Lincoln 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.