CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Cleveland Clinic Children's Hospital for Rehab

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $129
Cash Discount Price: $123
vs. Medicare Baseline: 3.68x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Cleveland Clinic Children's Hospital for Rehab is $129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $123. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.68x the Medicare baseline. Located in 2801 Martin Luther King, Jr Drive, Cleveland, OH.

Cash / Self-Pay

$123

Average discount available for prompt cash payment at this facility.

Insurance Median

$129

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: $123 (351%)

Insurance Median: $129 (368%)

Cash: $123 (351% of Medicare)

Ins. Median: $129 (368% 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 368% of the Medicare baseline (a markup of 268%). 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
Oscar	$57 - $73	163%
Aultcare	$64	182%
Aetna	$72 - $189	205%
Cigna	$82 - $151	234%
Amish Community Aid Plan	$85 - $94	242%
Ohcp	$92	262%
Summacare	$94 - $95	268%
Buckeye	$103 - $125	294%
Healthsmart	$104	297%
United	$108 - $132	308%
Php	$113	322%
Phphi	$113	322%
The Health Plan	$113	322%
Upmc	$113	322%
UnitedHealthcare	$117 - $139	334%
Paramount	$127	362%
Blue Cross Blue Shield	$129 - $143	368%
Molina	$130	371%
Caresource	$132	376%
Gms	$132	376%
Medical Benefit Corp	$132	376%
Quality Care Partners	$132	376%
Cc Ehp	$134	382%
Amerihealth	$136	388%
Consociate Health	$142	405%
Ohio Healthy	$151	431%
Managed Care Services	$170	485%
Multiplan	$170	485%
Three Rivers	$170	485%

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 $123.
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 Cleveland Clinic Children's Hospital for Rehab 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.