CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: St Francis Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $167
Cash Discount Price: $150
vs. Medicare Baseline: 4.76x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at St Francis Hospital is $167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $150. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.76x the Medicare baseline. Located in 1215 Franciscan Dr, Litchfield, IL.

Cash / Self-Pay

$150

Average discount available for prompt cash payment at this facility.

Insurance Median

$167

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: $150 (428%)

Insurance Median: $167 (476%)

Cash: $150 (428% of Medicare)

Ins. Median: $167 (476% 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 476% of the Medicare baseline (a markup of 376%). 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
Clear Spring Health of Illinois	$44	125%
Blue Cross Blue Shield	$44 - $48	125%
Humana	$44	125%
Wexford	$45	128%
Aetna	$46 - $146	131%
Molina Healthcare	$46 - $47	131%
UnitedHealthcare	$46 - $208	131%
Meridian Health Plan	$49	140%
Amish Community	$58	165%
Celtic Insurance Company	$105	299%
Claim Doc	$109	311%
Hopetrust	$120	342%
Wellfirst	$134	382%
First Health	$154	439%
Caterpillar, Inc.	$167	476%
Current Health Solutions	$175	499%
Healthlink	$177	505%
Consociate Group	$177	505%
Multiplan/Phcs	$177	505%
Healthcare Finest Network (Hfn)	$187	533%
Provider Network of America	$187	533%
Naphcare	$208	593%
Healthscope	$208	593%
Cigna	$208	593%
Illinois Breast and Cervical Cancer Program	$208	593%
Live360	$208	593%
Health Alliance Medical Plans	$208	593%
Interplan	$208	593%

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 $150.
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 St Francis 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.