CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Ohio State University State Health System

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $87
Cash Discount Price: Unavailable
vs. Medicare Baseline: 2.69x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Ohio State University State Health System is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.69x the Medicare baseline. Located in 410 West 10Th Avenue, Columbus, OH.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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%)

Insurance Median: $87 (269%)

Ins. Median: $87 (269% 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 269% of the Medicare baseline (a markup of 169%). 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
Mmo	$39 - $40	120%
Aetna	$49 - $139	151%
Osu Health Plan	$54 - $86	167%
Blue Cross Blue Shield	$65 - $168	201%
Ohio Ppo	$65 - $78	201%
Odrc	$70	216%
Healthspan	$73 - $83	225%
Humana	$80	247%
Cigna	$112	346%
Ohiohealth	$112 - $130	346%
Upper Ohio Valley	$114	352%
Lifetrac	$118	364%
Frontpath	$138	426%
Multiplan	$138	426%
Healthsmart	$156	481%
United	$314 - $331	969%

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 $X.
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 Ohio State University State Health System 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.