CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Mary Hitchcock Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $90
Cash Discount Price: $56
vs. Medicare Baseline: 2.78x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mary Hitchcock Memorial Hospital is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.78x the Medicare baseline. Located in 1 Medical Center Drive, Lebanon, NH.

Cash / Self-Pay

$56

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $56 (173%)

Insurance Median: $90 (278%)

Cash: $56 (173% of Medicare)

Ins. Median: $90 (278% 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 278% of the Medicare baseline (a markup of 178%). 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
Amerihealth Caritas Nh	$21 - $24	65%
Beacon Health Strategies/Carelon	$22 - $23	68%
Wellsense Health Plan	$22 - $34	68%
Granite State Health Plan	$23 - $25	71%
Harvard Pilgrim Health Care Of Ne	$24 - $130	74%
UnitedHealthcare	$29 - $141	90%
Blue Cross Blue Shield	$33 - $209	102%
Martin'S Point Generations Advantage	$33	102%
Martin'S Point Health Care	$33 - $63	102%
Mvp	$33 - $123	102%
Aetna	$34 - $129	105%
Ambetter / Centene	$34 - $107	105%
Cigna	$34 - $126	105%
Wellcare Health Plans	$34	105%
Mass General Brigham Health Plan	$94 - $114	290%
Tufts Health Plan	$104 - $136	321%
Maine Community Health Options	$117 - $135	361%
Coventry	$160	494%
First Health/Hcvm	$160	494%
Phcs	$166	512%
Corvel	$169	522%
Ccmsi	$175	540%

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 $56.
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 Mary Hitchcock Memorial Hospital 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.