CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Pinckneyville Community Hospital

Billing Code: 97530 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$62

about 1.8× the $35 Medicare rate · typically $33–$126

modeled estimate · not a bill or quote

Medicare pays $35 Fair price $62 Cash price $133 Hospital's list price $133

How we calculate the fair BaseRate →

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$47 - $115	134%
Blue Cross Blue Shieldmajor	$91 - $197	259%
Aetnamajor	$48 - $197	137%
Cignamajor	$104 - $116	297%
Humanamajor	$47 - $52	134%
Ambetter (Centene)	$197	562%
HealthLink	$99 - $110	282%
WellCare	$47 - $52	134%
+ 1 smaller / regional plan	$47 - $52

Government programs also on file: Medicaid.

Excludes 5 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 133), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97530.

Insurance Before you use insurance

Call your insurance company to confirm Pinckneyville Community Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 97530.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Pinckneyville Community Hospital

Compare: Occupational therapy (therapeutic activities) at other IL hospitals

Insurance negotiated median for the same procedure, sorted lowest first.