CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Wabash General Hospital 1

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $117
Cash Discount Price: $175
vs. Medicare Baseline: 3.34x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Wabash General Hospital 1 is $117. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $175. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.34x the Medicare baseline. Located in 1418 College Drive, Mount Carmel, IL.

Cash / Self-Pay

$175

Average discount available for prompt cash payment at this facility.

Insurance Median

$117

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: $175 (499%)

Insurance Median: $117 (334%)

Cash: $175 (499% of Medicare)

Ins. Median: $117 (334% 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 334% of the Medicare baseline (a markup of 234%). 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	$41 - $204	117%
UnitedHealthcare	$43 - $204	123%
Health Alliance Mcr Adv - All Plans	$44 - $208	125%
Aetna	$87 - $179	248%
Meridian Mcaid - All Plans	$87	248%
Molina Mcaid - All Plans	$87	248%
Healthlink Hmo	$97 - $148	277%
Cigna	$104 - $158	297%
Encore Combined Ip/Op Only	$104 - $158	297%
Hope Trust - All Plans	$104 - $158	297%
Healthlink Ppo - All Other Plans	$110 - $169	314%
Phcs - All Plans	$110 - $169	314%
Health Smart - All Plans	$117 - $179	334%
Hfn - All Plans	$117 - $179	334%
Multiplan - All Plans	$117 - $179	334%
Siho Network - All Plans	$117 - $179	334%
Encore Health Network Ip/Op Only - All Other Plans	$124 - $190	354%

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 $175.
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 Wabash General Hospital 1 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.