CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Fostoria Community Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $98
Cash Discount Price: $111
vs. Medicare Baseline: 2.79x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Fostoria Community Hospital is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.79x the Medicare baseline. Located in 501 Van Buren Street, Fostoria, OH.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

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: $111 (317%)

Insurance Median: $98 (279%)

Cash: $111 (317% of Medicare)

Ins. Median: $98 (279% 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 279% of the Medicare baseline (a markup of 179%). 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
Buckeye Community Health Plan	$18 - $126	51%
Meridian Health Plan Of Mi	$18	51%
Dayton Area Health Plan Dba Caresource	$19 - $124	54%
UnitedHealthcare	$19 - $125	54%
Paramount Health Care	$32 - $90	91%
Blue Cross Blue Shield	$33 - $147	94%
Health Alliance Plan	$33 - $128	94%
Health Value Management	$33 - $37	94%
Aetna	$37 - $119	106%
Buckeye Community Health Plan Inc	$37 - $62	106%
Veterans Affairs	$37	106%
Medical Mutual Of Ohio	$96 - $102	274%
Frontpath Health Coalition	$98	279%
Ohio Health Choice	$110	314%
Ohio Ppo Connect	$110 - $128	314%
Amerihealth	$131	374%
Health Ohio Network	$134	382%
Connecticut General Life Insurance Company	$136	388%

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 $111.
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 Fostoria Community Hospital 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.