CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adena Fayette Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $152
Cash Discount Price: $114
vs. Medicare Baseline: 4.69x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adena Fayette Medical Center is $152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $114. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.69x the Medicare baseline. Located in 1430 Columbus Avenue, Washington Ch, OH.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$152

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: $114 (352%)

Insurance Median: $152 (469%)

Cash: $114 (352% of Medicare)

Ins. Median: $152 (469% 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 469% of the Medicare baseline (a markup of 369%). 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
Blue Cross Blue Shield	$78 - $152	241%
Aetna	$94 - $181	290%
Buckeye Community Health Plan	$94	290%
Humana	$94	290%
Medical Mutual Of Ohio	$94 - $172	290%
Medigold	$94	290%
Molina	$94	290%
Care Source	$96	296%
Molina Marketplace	$103	318%
United Medical Resources Ohcp	$144	444%
UnitedHealthcare	$144 - $145	444%
Cigna	$158	488%
Ohio Ppo Connect	$160	494%
The Health Plan	$160	494%
Care Source Just4Me	$169	522%
Medical Mutual Of Ohio Supermed	$172	531%
First Health	$179	552%
Ohio Health Choice	$182	562%
Multiplan/Private Healthcare Systems	$217	670%
Sidecar Health	$258	796%

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 $114.
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 Adena Fayette Medical 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.