CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Jacksonville Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $121
Cash Discount Price: $199
vs. Medicare Baseline: 3.45x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Jacksonville Memorial Hospital is $121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $199. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.45x the Medicare baseline. Located in 1600 W Walnut St, Jacksonville, IL.

Cash / Self-Pay

$199

Average discount available for prompt cash payment at this facility.

Insurance Median

$121

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: $199 (567%)

Insurance Median: $121 (345%)

Cash: $199 (567% of Medicare)

Ins. Median: $121 (345% 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 345% of the Medicare baseline (a markup of 245%). 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	$26 - $222	74%
Coventry	$28 - $35	80%
Health Alliance	$28 - $151	80%
Humana	$28 - $189	80%
Medicare (plans)	$28 - $35	80%
UnitedHealthcare	$28 - $160	80%
Tricare	$32 - $40	91%
Corvel/Corcare	$44 - $82	125%
Illinois Workers Compensation	$47 - $74	134%
Commercial Workers Compensation	$70	200%
Medicaid / KanCare	$71	202%
Molina Healthcare	$71	202%
Health Alliance Mh Employee Plan	$80 - $102	228%
Current Health Network	$96 - $166	274%
6 Degrees Health	$105 - $133	299%
Hope Trust	$105 - $133	299%
Hst	$105 - $133	299%
Cigna	$121 - $154	345%
Aetna	$122 - $178	348%
Healthlink	$149 - $189	425%
Phcs/Multiplan	$158 - $200	451%
Hfn	$166 - $211	473%
Liability	$175 - $222	499%

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 $199.
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 Jacksonville 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.