CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Nationwide Children's Hospital Toledo, LLC

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $96
Cash Discount Price: $161
vs. Medicare Baseline: 2.74x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Nationwide Children's Hospital Toledo, LLC is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $161. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.74x the Medicare baseline. Located in 2213 Cherry Street, Toledo, OH.

Cash / Self-Pay

$161

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $161 (459%)

Insurance Median: $96 (274%)

Cash: $161 (459% of Medicare)

Ins. Median: $96 (274% 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 274% of the Medicare baseline (a markup of 174%). 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
Blue Cross Blue Shield	$28 - $137	80%
Tricare	$31	88%
Caresource	$33 - $48	94%
Paramount	$33	94%
Front Path Health Coalition	$43 - $121	123%
Molina	$45 - $96	128%
Mcclaren Health Plan	$47 - $121	134%
Mcclaren Health Plan - Michigan	$47	134%
Aetna	$48 - $104	137%
Mmo	$66 - $94	188%
Cigna	$96	274%
UnitedHealthcare	$96 - $136	274%
Amerihealth	$97	277%
Bchp	$97	277%
Humana	$97	277%
Ohc	$134 - $188	382%
Ohio Ppo Connect	$134 - $188	382%
First Health	$207	590%

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 $161.
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 Nationwide Children's Hospital Toledo, LLC 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.