CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Illini Community Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $289
Cash Discount Price: $204
vs. Medicare Baseline: 8.24x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Illini Community Hospital is $289. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $204. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 8.24x the Medicare baseline. Located in 640 W Washington, Pittsfield, IL.

Cash / Self-Pay

$204

Average discount available for prompt cash payment at this facility.

Insurance Median

$289

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: $204 (582%)

Insurance Median: $289 (824%)

Cash: $204 (582% of Medicare)

Ins. Median: $289 (824% 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 824% of the Medicare baseline (a markup of 724%). 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
Humana	$100	285%
Blue Cross Blue Shield	$175 - $289	499%
Blue Access	$204	582%
United Behavioral Health	$204	582%
UnitedHealthcare	$272	776%
Aetna	$289	824%
Blue Preferred	$289	824%
Cigna	$289	824%
Health Link	$289	824%
Private Healthcare Systems-Multi Plan Primary	$289	824%
Health Link Ppo	$306	873%
Private Healthcare Systems-Multi Plan Complementary	$306	873%

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 $204.
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 Illini Community 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.