CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Decatur Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $133
Cash Discount Price: $223
vs. Medicare Baseline: 3.79x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Decatur Memorial Hospital is $133. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $223. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.79x the Medicare baseline. Located in 2300 North Edward Street, Decatur, IL.

Cash / Self-Pay

$223

Average discount available for prompt cash payment at this facility.

Insurance Median

$133

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: $223 (636%)

Insurance Median: $133 (379%)

Cash: $223 (636% of Medicare)

Ins. Median: $133 (379% 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 379% of the Medicare baseline (a markup of 279%). 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	$30 - $223	86%
Aetna	$32 - $150	91%
Coventry	$32 - $134	91%
Health Alliance	$32 - $148	91%
Humana	$32 - $145	91%
Medicare (plans)	$32 - $33	91%
UnitedHealthcare	$32 - $223	91%
Veterans Administration	$32 - $33	91%
Wellcare	$32	91%
Tricare	$33 - $34	94%
Caterpillar	$41	117%
Medicaid / KanCare	$45 - $46	128%
Illinois Workers Compensation	$47 - $70	134%
Commercial Workers Compensation	$66	188%
Hfn	$66 - $167	188%
Mennonite Churches	$95 - $96	271%
Plain Church Medical Group	$100	285%
Health Alliance Mh Employee Plan	$102 - $103	291%
Cigna	$103 - $104	294%
6 Degrees Health	$133 - $134	379%
Hopetrust	$133 - $134	379%
Hst	$133 - $134	379%
Phcs Savility	$144 - $145	411%
Phcs Multiplan Ppo	$151 - $152	431%
Healthlink	$152 - $153	433%
Corvel	$160 - $161	456%
Consociate	$164 - $165	468%
Liability	$222 - $223	633%

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 $223.
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 Decatur Memorial 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.