CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Witham Health Services

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $173
Cash Discount Price: $146
vs. Medicare Baseline: 4.93x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Witham Health Services is $173. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $146. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.93x the Medicare baseline. Located in 2605 N Lebanon St, Lebanon, IN.

Cash / Self-Pay

$146

Average discount available for prompt cash payment at this facility.

Insurance Median

$173

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: $146 (416%)

Insurance Median: $173 (493%)

Cash: $146 (416% of Medicare)

Ins. Median: $173 (493% 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 493% of the Medicare baseline (a markup of 393%). 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	$33 - $222	94%
Mdwise Health In-All Plans	$33	94%
Aetna	$34 - $164	97%
Caresource Mcr Adv	$34	97%
Caresource Indiana Marketplace-All Other Plans	$64	182%
UnitedHealthcare	$154 - $173	439%
Humana	$183 - $206	522%
Phcs/Multiplan-All Plans	$184 - $202	525%
Sagamore-All Plans	$186 - $204	530%
Encore-All Plans	$187 - $210	533%
Beech Street-All Plans	$190 - $208	542%
Mhs Comml Exch-All Plans	$492 - $554	1403%

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 $146.
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 Witham Health Services 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.