CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Adena Fayette Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $154
Cash Discount Price: $116
vs. Medicare Baseline: 4.39x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Adena Fayette Medical Center is $154. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $116. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.39x the Medicare baseline. Located in 1430 Columbus Avenue, Washington Ch, OH.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$154

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: $116 (331%)

Insurance Median: $154 (439%)

Cash: $116 (331% of Medicare)

Ins. Median: $154 (439% 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 439% of the Medicare baseline (a markup of 339%). 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
Blue Cross Blue Shield	$79 - $154	225%
Aetna	$95 - $184	271%
Buckeye Community Health Plan	$95	271%
Humana	$95	271%
Medical Mutual Of Ohio	$95 - $175	271%
Medigold	$95	271%
Molina	$95	271%
Care Source	$97	277%
Molina Marketplace	$105	299%
United Medical Resources Ohcp	$146	416%
UnitedHealthcare	$146 - $148	416%
Cigna	$160	456%
Ohio Ppo Connect	$163	465%
The Health Plan	$163	465%
Care Source Just4Me	$172	490%
Medical Mutual Of Ohio Supermed	$175	499%
First Health	$182	519%
Ohio Health Choice	$185	528%
Multiplan/Private Healthcare Systems	$221	630%
Sidecar Health	$263	750%

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 $116.
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 Adena Fayette 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.