Occupational therapy (self-care training)
Facility: Akron Children's Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $167
- Cash Discount Price: $165
- vs. Medicare Baseline: 5.15x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 515% of the Medicare baseline (a markup of 415%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Caresource | $42 | 130% |
| Aetna | $43 - $219 | 133% |
| Blue Cross Blue Shield | $43 - $252 | 133% |
| Buckeye Community Health Plan | $43 | 133% |
| Cenpatico | $43 | 133% |
| Molina | $43 | 133% |
| Amerihealth Caritas Ohio | $44 | 136% |
| Humana | $44 - $237 | 136% |
| UnitedHealthcare | $44 - $219 | 136% |
| Healthplan (Hometown) | $63 - $87 | 194% |
| Summacare | $63 - $209 | 194% |
| Northern Ohio Handicapped Fund (Nohf | $67 - $92 | 207% |
| Ohio Crippled Childrens Fund (Occf | $67 - $92 | 207% |
| Amish Church Fund | $93 - $128 | 287% |
| Medben | $141 - $194 | 435% |
| Mmo | $144 - $251 | 444% |
| Summa Health Employee | $145 - $199 | 448% |
| Summacare Preferred Choice Network | $146 - $201 | 451% |
| Autlcare | $147 - $201 | 454% |
| The Health Plan (Mountaineer Region) | $150 - $205 | 463% |
| Avita-Osu Health Plan | $153 - $209 | 472% |
| The Health Plan (Fna Hometown Health Network) | $156 - $214 | 481% |
| Cigna | $158 - $220 | 488% |
| Healthsmart (Fna Emerald Health Network) | $163 - $223 | 503% |
| Embs/Thomas Steel | $164 - $224 | 506% |
| Ohio Health Choice | $164 - $224 | 506% |
| Phcs/Multiplan | $164 - $224 | 506% |
| Enterprise Group Planning | $167 - $230 | 515% |
| Prime Health Services | $167 - $230 | 515% |
| Primenet | $167 - $230 | 515% |
| Quality Care Partners | $167 - $230 | 515% |
| Beechstreet | $173 - $237 | 534% |
| Ohio Preferred Network | $173 - $237 | 534% |
| Paramount | $173 - $237 | 534% |
| Cofinity | $175 - $240 | 540% |
| Health Reach Ohio Health Group | $175 - $240 | 540% |
| Direct Care America | $177 - $242 | 546% |
| First Health Network | $177 - $242 | 546% |