CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Ocean Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $161
Cash Discount Price: $45
vs. Medicare Baseline: 4.59x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Ocean Medical Center is $161. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $45. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.59x the Medicare baseline. Located in 425 Jack Martin Blvd, Brick, NJ.

Cash / Self-Pay

$45

Average discount available for prompt cash payment at this facility.

Insurance Median

$161

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: $45 (128%)

Insurance Median: $161 (459%)

Cash: $45 (128% of Medicare)

Ins. Median: $161 (459% 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 459% of the Medicare baseline (a markup of 359%). 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
Aetna	$27 - $221	77%
Clover	$34 - $47	97%
Seoul Medical Group	$36 - $56	103%
Amerigroup	$45 - $57	128%
Horizon	$45 - $188	128%
Vaccn	$45	128%
United Community/Americhoice	$47	134%
UnitedHealthcare	$54 - $558	154%
Karna	$61 - $64	174%
Blue Cross Blue Shield	$104	297%
Horizon - Jri@Oumc	$116 - $205	331%
Cigna	$130 - $251	371%
Qualcare	$146 - $306	416%
Activecare First McO	$160 - $183	456%
Multiplan - PHCS	$160 - $222	456%
Amerihealth	$162 - $258	462%
Intergroup	$183	522%
Oxford - Jri@Oumc	$193	550%
Prime Health	$209	596%
Wellcare	$224	639%
Bergen Risk	$291	830%
Brighton Health Plan	$355 - $525	1012%
Oxford	$414 - $495	1180%
Brighton Health Plan - Jri@Oumc	$500	1426%

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 $45.
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 Ocean Medical Center 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.