CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adena Pike Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $172
Cash Discount Price: $114
vs. Medicare Baseline: 5.31x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adena Pike Medical Center is $172. 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 5.31x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$114

Average discount available for prompt cash payment at this facility.

Insurance Median

$172

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: $172 (531%)

Cash: $114 (352% of Medicare)

Ins. Median: $172 (531% 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 531% of the Medicare baseline (a markup of 431%). 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
Aetna	$55 - $186	170%
Blue Cross Blue Shield	$55 - $197	170%
Buckeye Community Health Plan	$55	170%
Humana	$55 - $217	170%
Medical Mutual Of Ohio	$55 - $145	170%
Medigold	$55	170%
Molina	$55	170%
Care Source	$56	173%
Gateway Health	$75	231%
Molina Marketplace	$90	278%
Care Source Just4Me	$99	306%
Sidecar Health	$151	466%
Ohio Ppo Connect	$160	494%
The Health Plan	$160	494%
Cigna	$166	512%
Medical Mutual Of Ohio Supermed	$172	531%
First Health	$179	552%
Ohio Health Choice	$182	562%
UnitedHealthcare	$197	608%
Integrated Health Plan	$215	664%
Healthsmart	$217	670%
Multiplan/Private Healthcare Systems	$217	670%
Three Rivers Network	$217	670%

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 Pike 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.