CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: South Pointe Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $116
Cash Discount Price: $165
vs. Medicare Baseline: 3.58x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at South Pointe Hospital is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $165. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.58x the Medicare baseline. Located in 20000 Harvard Road, Warrensville Heights, OH.

Cash / Self-Pay

$165

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $165 (509%)

Insurance Median: $116 (358%)

Cash: $165 (509% of Medicare)

Ins. Median: $116 (358% 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 358% of the Medicare baseline (a markup of 258%). 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
UnitedHealthcare	$28 - $157	86%
Paramount	$30	93%
Blue Cross Blue Shield	$31 - $164	96%
Buckeye	$31	96%
Molina	$31	96%
Amerihealth	$32	99%
Caresource	$32	99%
United	$32 - $238	99%
Aetna	$41 - $254	127%
Humana	$41 - $216	127%
Summacare	$41 - $95	127%
The Health Plan	$41 - $152	127%
Upmc	$41 - $152	127%
Valor	$41	127%
Cigna	$42 - $203	130%
Perennial Health	$44	136%
Oscar	$77 - $98	238%
Cc Ehp	$101 - $103	312%
Aultcare	$109	336%
Ohcp	$123	380%
Omas	$127	392%
Mmo	$136 - $152	420%
Ohio Healthy	$137	423%
Healthsmart	$140	432%
Php	$152	469%
Gms	$178	549%
Medical Benefit Corp	$178	549%
Quality Care Partners	$178	549%
Consociate Health	$190	586%
Frontpath	$229	707%
Managed Care Services	$229	707%
Multiplan	$229	707%
Tertiary Care Network	$229	707%
Three Rivers	$229	707%

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 $165.
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 South Pointe 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.