CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Northwestern Medicine Central Dupage Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $142
Cash Discount Price: $169
vs. Medicare Baseline: 4.05x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Northwestern Medicine Central Dupage Hospital is $142. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $169. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.05x the Medicare baseline. Located in 25 North Winfield Road, Winfield, IL.

Cash / Self-Pay

$169

Average discount available for prompt cash payment at this facility.

Insurance Median

$142

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: $169 (482%)

Insurance Median: $142 (405%)

Cash: $169 (482% of Medicare)

Ins. Median: $142 (405% 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 405% of the Medicare baseline (a markup of 305%). 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	$17 - $241	48%
Countycare Il Cook Co [1607]	$17	48%
Medicaid / KanCare	$17	48%
Aetna	$34 - $139	97%
Cigna	$52 - $193	148%
Carelon Behavioral Health [159]	$120	342%
Health'S Finest Network [126]	$120 - $220	342%
UnitedHealthcare	$121 - $241	345%
Multiplan/Phcs [142]	$138 - $241	393%
Dreyer Med Ipa Advocate [1409]	$145	413%
Humana	$145 - $241	413%
Magellan Behavioral Hlth [136]	$145	413%
Healthlink [125]	$152	433%
The Alliance [1703]	$155	442%
Choicecare [177]	$185	528%
First Health Plan [6034]	$185	528%
Compsych [112]	$193	550%

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 $169.
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 Northwestern Medicine Central Dupage 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.