CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Hamilton Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $71
Cash Discount Price: $77
vs. Medicare Baseline: 2.02x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Hamilton Memorial Hospital is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $77. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.02x the Medicare baseline. Located in 611 S Marshall Avenue, McLeansboro, IL.

Cash / Self-Pay

$77

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

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: $77 (220%)

Insurance Median: $71 (202%)

Cash: $77 (220% of Medicare)

Ins. Median: $71 (202% 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 202% of the Medicare baseline (a markup of 102%). 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
Medicaid / KanCare	$31 - $39	88%
Blue Cross Blue Shield	$32 - $89	91%
Aetna	$34 - $88	97%
Health Alliance	$34 - $78	97%
Humana	$34 - $39	97%
Medicare (plans)	$34 - $39	97%
UnitedHealthcare	$34 - $70	97%
Wellcare	$34 - $39	97%
Alliance Coal	$59 - $68	168%
Healthscope	$59 - $68	168%
Wellfirst (Ssmhic)	$59 - $68	168%
Hope Trust	$63 - $73	180%
Cigna	$66 - $77	188%
Hfn, Inc	$67 - $88	191%
Healthlink	$71 - $88	202%
Multiplan	$71 - $83	202%
Siho	$76 - $88	217%
Three Rivers Provider	$76 - $88	217%
Healthsmart	$80 - $93	228%
Stratose	$80 - $93	228%

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 $77.
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 Hamilton 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.