CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: University Hospitals Avon Rehabilitation Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $111
Cash Discount Price: $111
vs. Medicare Baseline: 3.17x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at University Hospitals Avon Rehabilitation Hospital is $111. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.17x the Medicare baseline. Located in 37900 Chester Rd, Avon, OH.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$111

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: $111 (317%)

Insurance Median: $111 (317%)

Cash: $111 (317% of Medicare)

Ins. Median: $111 (317% 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 317% of the Medicare baseline (a markup of 217%). 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
Uh Employees (Administered By Meritian)	$43	123%
Blue Cross Blue Shield	$64 - $111	182%
Healthsmart (Formerly Emerald)	$72	205%
Ohio Health Choice - Preferred Choice Plus	$72	205%
Clarity Health (Enterprise Group Planning Will Be Listed On Id Card As Well)	$82	234%
Occunet Fka Health Ohio Network	$82	234%
Paramount	$83 - $111	237%
Ohio Preferred Network	$88	251%
First Health	$94	268%
Beechstreet	$99	282%
Fortified	$99	282%
Multiplan	$99	282%
Ohio Health Choice	$99	282%
Phcs	$99	282%
Aetna	$111	317%
Ambetter / Centene	$111	317%
Amerihealth Cartias	$111	317%
Antidote Healthe Care Of Ohio	$111	317%
Aultcare	$111	317%
Buckeye	$111	317%
Caresource	$111	317%
Caresource (Marketplace)	$111	317%
Cigna	$111	317%
Devoted	$111	317%
Health Plan	$111	317%
Humana	$111	317%
Jp Farley (Select Employers)	$111	317%
Medical Mutual	$111	317%
Medical Mutual (Supermed, Trad, Medflex)	$111	317%
Medical Mutual (Marketplace Plan)	$111	317%
Molina	$111	317%
Summacare	$111	317%
United	$111	317%
UnitedHealthcare	$111	317%
Wellcare	$111	317%

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 $111.
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 University Hospitals Avon Rehabilitation Hospital 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.