CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Memorial Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $133
Cash Discount Price: $222
vs. Medicare Baseline: 3.79x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Memorial Medical Center is $133. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $222. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.79x the Medicare baseline. Located in 701 N First St, Springfield, IL.

Cash / Self-Pay

$222

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: $222 (633%)

Insurance Median: $133 (379%)

Cash: $222 (633% 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
Veterans Administration	$23	66%
Blue Cross Blue Shield	$30 - $222	86%
Aetna	$32 - $169	91%
Health Alliance	$32 - $144	91%
Medicare (plans)	$32 - $222	91%
Tricare	$32	91%
UnitedHealthcare	$32 - $138	91%
Humana	$34 - $133	97%
Medicaid / KanCare	$45	128%
Molina	$46	131%
Commercial Workers Compensation	$90	257%
Illinois Workers Compensation	$95	271%
Current Health Network Ppo	$100	285%
Healthlink	$111 - $140	317%
Cigna	$117	334%
Phcs/Multiplan	$120 - $133	342%
6 Degrees Health	$133	379%
Hopetrust	$133	379%
Hst	$133	379%
Magellan	$133	379%
Consociate	$144	411%
Hfn	$144	411%
Preferred Plan	$166	473%
Soi Mcfarland	$166	473%
Soi Rushville	$166	473%
Corvel	$178	508%
Methodist First Choice	$178	508%
Mutual Medical Plans	$189	539%
Liability	$222	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 $222.
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 Memorial 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.