CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: South Pointe Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $116
Cash Discount Price: $165
vs. Medicare Baseline: 3.31x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) 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 $35.07, this hospital’s rate is 3.31x 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

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $165 (470%)

Insurance Median: $116 (331%)

Cash: $165 (470% of Medicare)

Ins. Median: $116 (331% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 331% of the Medicare baseline (a markup of 231%). 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	$45 - $254	128%
Humana	$45 - $216	128%
Summacare	$45 - $95	128%
The Health Plan	$45 - $152	128%
UnitedHealthcare	$45 - $157	128%
Upmc	$45 - $152	128%
Valor	$45	128%
Cigna	$46 - $203	131%
United	$47 - $238	134%
Perennial Health	$48	137%
Oscar	$77 - $98	220%
Paramount	$83	237%
Blue Cross Blue Shield	$85 - $164	242%
Buckeye	$85	242%
Molina	$85	242%
Caresource	$86	245%
Amerihealth	$89	254%
Cc Ehp	$101 - $103	288%
Aultcare	$109	311%
Ohcp	$123	351%
Omas	$127	362%
Mmo	$136 - $152	388%
Ohio Healthy	$137	391%
Healthsmart	$140	399%
Php	$152	433%
Gms	$178	508%
Medical Benefit Corp	$178	508%
Quality Care Partners	$178	508%
Consociate Health	$190	542%
Frontpath	$229	653%
Managed Care Services	$229	653%
Multiplan	$229	653%
Tertiary Care Network	$229	653%
Three Rivers	$229	653%

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: 97530.

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 97530.
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.