CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Cleveland Clinic Children's Hospital for Rehab

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $88
Cash Discount Price: $96
vs. Medicare Baseline: 2.72x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Cleveland Clinic Children's Hospital for Rehab is $88. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $96. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.72x the Medicare baseline. Located in 2801 Martin Luther King, Jr Drive, Cleveland, OH.

Cash / Self-Pay

$96

Average discount available for prompt cash payment at this facility.

Insurance Median

$88

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: $96 (296%)

Insurance Median: $88 (272%)

Cash: $96 (296% of Medicare)

Ins. Median: $88 (272% 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 272% of the Medicare baseline (a markup of 172%). 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
UnitedHealthcare	$43 - $108	133%
Oscar	$44 - $57	136%
Paramount	$46	142%
Blue Cross Blue Shield	$47 - $111	145%
Molina	$47	145%
Caresource	$48	148%
United	$48 - $84	148%
Amerihealth	$50	154%
Aultcare	$50	154%
Cigna	$64 - $118	198%
Amish Community Aid Plan	$66 - $74	204%
Ohcp	$71	219%
Aetna	$73 - $147	225%
Summacare	$73 - $74	225%
Buckeye	$80 - $97	247%
Healthsmart	$81	250%
Php	$88	272%
Phphi	$88	272%
The Health Plan	$88	272%
Upmc	$88	272%
Gms	$103	318%
Medical Benefit Corp	$103	318%
Quality Care Partners	$103	318%
Cc Ehp	$104	321%
Consociate Health	$110	340%
Ohio Healthy	$118	364%
Managed Care Services	$132	407%
Multiplan	$132	407%
Three Rivers	$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 $96.
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 Cleveland Clinic Children's Hospital for Rehab 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.