CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Fairfield Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $90
Cash Discount Price: $78
vs. Medicare Baseline: 2.57x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Fairfield Medical Center is $90. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.57x the Medicare baseline. Located in 401 North Ewing Street, Lancaster, OH.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$90

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: $78 (222%)

Insurance Median: $90 (257%)

Cash: $78 (222% of Medicare)

Ins. Median: $90 (257% 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 257% of the Medicare baseline (a markup of 157%). 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
Humana	$30 - $164	86%
Aetna	$33 - $113	94%
Blue Cross Blue Shield	$33 - $26,250	94%
Buckeye Community Health	$33 - $83	94%
Medical Mutual	$33 - $33,500	94%
Medicare (plans)	$33	94%
Medigold	$33	94%
Molina	$33 - $79	94%
The Health Plan	$33 - $120	94%
UnitedHealthcare	$33 - $141	94%
Va Ccn	$33	94%
Valor Health Plan	$33	94%
Caresource	$34 - $80	97%
Bwc	$46	131%
Oscar	$62	177%
Medicaid / KanCare	$79	225%
Amerihealth Caritas Ohio	$83	237%
Allied Benefit Systems	$120	342%
Meritain Health	$120	342%
Quality Care Partners/Ohio Ppo Connect	$125	356%
The Ohio State Health Plan	$133	379%
Cigna	$143	408%
Ohio Healthy	$163	465%
Multiplan	$164	468%
Miscellaneous Plans	$173	493%

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 $78.
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 Fairfield 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.