CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Southwest General Health Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $116
Cash Discount Price: $168
vs. Medicare Baseline: 3.31x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Southwest General Health Center is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $168. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.31x the Medicare baseline. Located in 18697 Bagley Road, Middleburg Heights, OH.

Cash / Self-Pay

$168

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: $168 (479%)

Insurance Median: $116 (331%)

Cash: $168 (479% 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
Medical Mutual	$19 - $22	54%
Medical Mutual-Ohio	$19	54%
Buckeye	$60 - $116	171%
Molina	$60 - $116	171%
Healthsmart	$72	205%
Health Design Plus	$83	237%
Humana	$87 - $116	248%
Clarity Health	$90	257%
Healthspan	$90	257%
Healthsmart Preferred	$101	288%
Ohio Health Choice Plus	$108	308%
Amerihealth Caritas	$116	331%
Blue Cross Blue Shield	$116	331%
Caresource	$116	331%
UnitedHealthcare	$116 - $121	331%
Aetna	$121	345%
Summacare	$121	345%
Coventry	$155	442%
First Health	$155	442%
Ohio Health Choice	$173	493%
Private Healthare Systems	$179	510%
Cigna	$184	525%

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 $168.
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 Southwest General Health Center 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.