CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Diley Ridge Medical Center
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $64
- Cash Discount Price: $89
- vs. Medicare Baseline: 1.98x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Diley Ridge Medical Center is $64. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $89. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.98x the Medicare baseline. Located in 7911 Diley Road, Canal Winchester, OH.
Cash / Self-Pay
$89
Average discount available for prompt cash payment at this facility.
Insurance Median
$64
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: $89 (275%)
Insurance Median: $64 (198%)
Cash: $89 (275% of Medicare)
Ins. Median: $64 (198% 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.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicare (plans) | $27 - $33 | 83% |
| Aetna | $30 - $137 | 93% |
| Blue Cross Blue Shield | $30 - $137 | 93% |
| UnitedHealthcare | $31 - $250 | 96% |
| The Health Plan | $32 - $90 | 99% |
| Blue Benefit Administrators Of Massachusetts | $40 | 123% |
| Blue Care Network | $40 | 123% |
| Blue Distinction Transplant | $40 | 123% |
| Blue Shield - Ca | $40 | 123% |
| Blue Shield - Id (Regence) | $40 | 123% |
| Blue Shield - Ny Highmark Northeastern | $40 | 123% |
| Blue Shield - Ny Highmark Western | $40 | 123% |
| Blue Shield - Pa (Highmark) | $40 | 123% |
| Blue Shield - Wa (Regence) | $40 | 123% |
| Hospice Mount Carmel | $51 | 157% |
| Oscar | $51 | 157% |
| Enterprise Group Planning | $60 | 185% |
| Geha | $62 - $250 | 191% |
| Gravie Admin Services | $62 | 191% |
| Healthez | $62 | 191% |
| Meritain | $62 | 191% |
| Webtpa | $62 | 191% |
| Access Health | $64 | 198% |
| Acclaim | $64 | 198% |
| Administrative Concepts | $64 | 198% |
| Allegeant | $64 | 198% |
| Allied Benefit Systems | $64 | 198% |
| American Family | $64 | 198% |
| American Healthcare Alliance | $64 | 198% |
| American National | $64 | 198% |
| American Republic | $64 | 198% |
| Amerihealth | $64 | 198% |
| Aultcare | $64 | 198% |
| Automated Benefit Services | $64 | 198% |
| Auxiant | $64 | 198% |
| Benefit Administrative Systems,Llc | $64 | 198% |
| Boon Chapman | $64 | 198% |
| Cam Administrative Services | $64 | 198% |
| Christian Brother Services | $64 | 198% |
| Christian Brothers Holy Cross | $64 | 198% |
| Claimchoice Adminstrators | $64 | 198% |
| Comprehensive Benefits | $64 | 198% |
| Continental Life Insurance | $64 | 198% |
| Coventry | $64 | 198% |
| Custom Benefit Administrators | $64 | 198% |
| Cypress Benefit Administrators | $64 | 198% |
| Employee Benefit Concepts | $64 | 198% |
| Employee Benefit Management | $64 | 198% |
| Forest County Potawatomi | $64 | 198% |
| Freedom Life Insurance Company | $64 | 198% |
| Group Administrators | $64 | 198% |
| Group Marketing Services | $64 | 198% |
| Group Pension Administrators | $64 | 198% |
| Guardian | $64 | 198% |
| Health America | $64 | 198% |
| Health Choices | $64 | 198% |
| Healthcare Management Admin | $64 | 198% |
| Insight | $64 | 198% |
| Intercare | $64 | 198% |
| Jfp Benefit Management | $64 | 198% |
| Jp Farley Corporation | $64 | 198% |
| Key Benefit Administrator | $64 | 198% |
| Liberty Union Life Assurance Co | $64 | 198% |
| Lucent Health | $64 | 198% |
| Luminare Health | $64 | 198% |
| Magnacare | $64 | 198% |
| Medcost | $64 | 198% |
| Mutual Health Services | $64 | 198% |
| Mutual Of Omaha | $64 | 198% |
| Ncas | $64 | 198% |
| Nippon Life Ins | $64 | 198% |
| Nova | $64 | 198% |
| Painters Union Insurance Fund | $64 | 198% |
| Physicians Mutual | $64 | 198% |
| Plumbers Local 98 Insurance Fund | $64 | 198% |
| Prairie States | $64 | 198% |
| Preferred One | $64 | 198% |
| Primary Physician Care | $64 | 198% |
| Professional Benefit Administrators | $64 | 198% |
| Secureone Preferred United Plans | $64 | 198% |
| Siho Insurance Services | $64 | 198% |
| Sisco Benefits | $64 | 198% |
| The Loomis Company | $64 | 198% |
| Trustmark Small Business Benefits | $64 | 198% |
| U Of M Health Plan | $64 | 198% |
| Unicare | $64 | 198% |
| Unified Group Services | $64 | 198% |
| Us Health And Life | $64 | 198% |
| Valenz | $64 | 198% |
| Varipro | $64 | 198% |
| Wps | $64 | 198% |
| Custom Design Benefits | $65 | 201% |
| Medben | $68 - $103 | 210% |
| Humana | $70 - $137 | 216% |
| Quality Care Partners | $70 | 216% |
| First Health | $72 | 222% |
| Consociate | $84 | 259% |
| Health Ohio Network | $84 | 259% |
| Rural Carrier Health Benefit Plan | $96 | 296% |
| Caresource | $100 | 309% |
| Healthlink Inc | $103 | 318% |
| Medical Benefits Mutual | $103 | 318% |
| Ohio Health Choice | $103 | 318% |
| Ohio Ppo Connect | $103 | 318% |
| Medical Mutual | $104 | 321% |
| Medi Share | $109 | 336% |
| Multiplan | $109 | 336% |
| Phcs | $109 | 336% |
| Philadelphia American Life Insurance | $109 | 336% |
| Ameriben | $110 | 340% |
| Luminare Health (Detroit) | $110 | 340% |
| Ohiohealthy | $110 | 340% |
| Osu Not Independent Choice | $110 | 340% |
| Twin Valley Psychiatric | $110 | 340% |
| Health Smart | $116 | 358% |
| Bccp | $137 | 423% |
| Medicaid / KanCare | $137 | 423% |
| Optima Health | $137 | 423% |
| American Postal Workers Secondary | $232 | 716% |
| Cigna | $232 | 716% |
| Health Partners | $232 | 716% |
| Healthgram | $232 | 716% |
| Mvp | $232 | 716% |
| Priority Health | $232 | 716% |
| Crime Victim Assistance | $632 | 1951% |
| Ohio Safe Program | $632 | 1951% |