CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Cayuga Medical Center at Ithaca

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $121
Cash Discount Price: $36
vs. Medicare Baseline: 3.45x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Cayuga Medical Center at Ithaca is $121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.45x the Medicare baseline. Located in 101 Dates Drive, Ithaca, NY.

Cash / Self-Pay

$36

Average discount available for prompt cash payment at this facility.

Insurance Median

$121

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: $36 (103%)

Insurance Median: $121 (345%)

Cash: $36 (103% of Medicare)

Ins. Median: $121 (345% 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 345% of the Medicare baseline (a markup of 245%). 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
Molina	$5 - $65	14%
Aetna	$45 - $167	128%
Excellus	$45 - $169	128%
Cigna	$115 - $181	328%
UnitedHealthcare	$126 - $198	359%
Emblem Health	$129 - $202	368%
Independent Health	$133 - $209	379%
Wellcare	$141 - $222	402%
Martins Point	$143 - $224	408%
Fidelis	$312 - $489	890%

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 $36.
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 Cayuga Medical Center at Ithaca 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.