CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Lexington Memorial Hospital Inc

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $73
Cash Discount Price: $83
vs. Medicare Baseline: 2.08x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Lexington Memorial Hospital Inc is $73. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.08x the Medicare baseline. Located in 250 Hospital Drive Po Box 1817, Lexington, NC.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$73

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: $83 (237%)

Insurance Median: $73 (208%)

Cash: $83 (237% of Medicare)

Ins. Median: $73 (208% 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 208% of the Medicare baseline (a markup of 108%). 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
Amerihealth	$31 - $45	88%
Carolina Complete	$31	88%
Healthy Blue	$31	88%
Partners	$31	88%
UnitedHealthcare	$31 - $74	88%
Vaya	$31	88%
Wellcare	$31	88%
Alliance	$32	91%
Trillium	$32	91%
Medcost	$36 - $110	103%
Blue Cross Blue Shield	$39 - $62	111%
Aetna	$47 - $152	134%
Ambetter / Centene	$47	134%
Oscar	$53 - $73	151%
Cigna	$72 - $73	205%
Directnet	$98	279%
Healthgram Lexington Home Brands	$119	339%
Healthgram	$132	376%
Private Healthcare Systems	$135	385%
Beechstreet	$145	413%
Humana	$145	413%
Multiplan	$148	422%
National Provider Network	$148	422%

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 $83.
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 Lexington Memorial Hospital Inc 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.