CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Fostoria Community Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $87
Cash Discount Price: $107
vs. Medicare Baseline: 2.69x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Fostoria Community Hospital is $87. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $107. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.69x the Medicare baseline. Located in 501 Van Buren Street, Fostoria, OH.

Cash / Self-Pay

$107

Average discount available for prompt cash payment at this facility.

Insurance Median

$87

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: $107 (330%)

Insurance Median: $87 (269%)

Cash: $107 (330% of Medicare)

Ins. Median: $87 (269% 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 269% of the Medicare baseline (a markup of 169%). 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
Meridian Health Plan Of Mi	$17	52%
Buckeye Community Health Plan	$22 - $46	68%
Dayton Area Health Plan Dba Caresource	$23 - $68	71%
UnitedHealthcare	$23 - $99	71%
Blue Cross Blue Shield	$30 - $136	93%
Health Alliance Plan	$30 - $124	93%
Health Value Management	$30 - $36	93%
Paramount Health Care	$30 - $87	93%
Aetna	$35 - $111	108%
Buckeye Community Health Plan Inc	$35 - $60	108%
Veterans Affairs	$36	111%
Amerihealth	$48	148%
Medical Mutual Of Ohio	$93 - $99	287%
Frontpath Health Coalition	$95	293%
Ohio Health Choice	$107	330%
Ohio Ppo Connect	$107 - $124	330%
Health Ohio Network	$130	401%
Connecticut General Life Insurance Company	$132	407%

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 $107.
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 Fostoria Community 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.