CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Uh St John Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $89
Cash Discount Price: $134
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Uh St John Medical Center is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $134. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.75x the Medicare baseline. Located in 29000 Center Ridge Road, Westlake, OH.

Cash / Self-Pay

$134

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $134 (414%)

Insurance Median: $89 (275%)

Cash: $134 (414% of Medicare)

Ins. Median: $89 (275% 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 275% of the Medicare baseline (a markup of 175%). 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
Aetna	$31 - $121	96%
Blue Cross Blue Shield	$31 - $100	96%
Cigna	$31 - $190	96%
Devoted Health	$31	96%
Humana	$31	96%
Molina	$31	96%
Paramount	$31	96%
Primetime Health Plan	$31	96%
Summacare	$31 - $91	96%
The Health Plan	$31 - $117	96%
UnitedHealthcare	$31 - $91	96%
Wellcare By Allwell	$31	96%
Perennial Advantage Of Ohio	$32	99%
Valor Health Plans	$32	99%
Medical Mutual Of Ohio	$48 - $75	148%
Ambetter / Centene	$55	170%
Caresource	$55	170%
University Health Employee Plan (Contigo)	$71	219%
Amish Aid Community Plan	$82 - $85	253%
Amish Church Fund And Workers Aid Plan	$82 - $85	253%
Buckeye Plain Ministries	$82 - $85	253%
Jp Farley	$84	259%
Clarity	$85	262%
Christian Healthcare Ministries	$89	275%
Immergrun	$89	275%
Sunrise Plan Communities	$89	275%
Aultcare	$98	302%
Healthsmart	$116	358%
Ohio Health Choice	$116 - $160	358%
Medical Mutual Traditional/Health Ohio	$125	386%
Beech Street	$142 - $160	438%
Ohio Preferred Network	$142 - $160	438%
First Health	$148	457%
Century Health Network	$151	466%
Private Healthcare System	$153	472%
Configurenet	$160	494%
Fortified Provider Network	$160	494%
Multiplan	$160	494%

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 $134.
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 Uh St John Medical Center 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.