CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Adena Pike Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $175
Cash Discount Price: $116
vs. Medicare Baseline: 4.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Adena Pike Medical Center is $175. 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 4.99x the Medicare baseline. Located in 100 Dawn Lane, Waverly, OH.

Cash / Self-Pay

$116

Average discount available for prompt cash payment at this facility.

Insurance Median

$175

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: $175 (499%)

Cash: $116 (331% of Medicare)

Ins. Median: $175 (499% 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 499% of the Medicare baseline (a markup of 399%). 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	$56 - $189	160%
Blue Cross Blue Shield	$56 - $201	160%
Buckeye Community Health Plan	$56	160%
Humana	$56 - $221	160%
Medical Mutual Of Ohio	$56 - $148	160%
Medigold	$56	160%
Molina	$56	160%
Care Source	$57	163%
Gateway Health	$77	220%
Molina Marketplace	$92	262%
Care Source Just4Me	$101	288%
Sidecar Health	$154	439%
Ohio Ppo Connect	$163	465%
The Health Plan	$163	465%
Cigna	$169	482%
Medical Mutual Of Ohio Supermed	$175	499%
First Health	$182	519%
Ohio Health Choice	$185	528%
UnitedHealthcare	$200	570%
Integrated Health Plan	$219	624%
Healthsmart	$221	630%
Multiplan/Private Healthcare Systems	$221	630%
Three Rivers Network	$221	630%

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 Pike 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.