CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Southwest General Health Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $80
Cash Discount Price: $162
vs. Medicare Baseline: 2.47x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Southwest General Health Center is $80. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $162. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.47x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.

Cash / Self-Pay

$162

Average discount available for prompt cash payment at this facility.

Insurance Median

$80

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: $162 (500%)

Insurance Median: $80 (247%)

Cash: $162 (500% of Medicare)

Ins. Median: $80 (247% 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 247% of the Medicare baseline (a markup of 147%). 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
Medical Mutual	$18 - $20	56%
Medical Mutual-Ohio	$18	56%
Buckeye	$55 - $73	170%
Molina	$55 - $73	170%
Healthsmart	$69	213%
Amerihealth Caritas	$73	225%
Blue Cross Blue Shield	$73	225%
Caresource	$73	225%
Humana	$73 - $84	225%
UnitedHealthcare	$73 - $117	225%
Health Design Plus	$80	247%
Clarity Health	$86	265%
Healthspan	$86	265%
Healthsmart Preferred	$97	299%
Ohio Health Choice Plus	$105	324%
Aetna	$117	361%
Summacare	$117	361%
Coventry	$149	460%
First Health	$149	460%
Ohio Health Choice	$167	515%
Private Healthare Systems	$173	534%
Cigna	$184	568%

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 $162.
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 Southwest General Health 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.