CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Rush Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $152
Cash Discount Price: $170
vs. Medicare Baseline: 4.69x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Rush Memorial Hospital is $152. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $170. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.69x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$170

Average discount available for prompt cash payment at this facility.

Insurance Median

$152

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $170 (525%)

Insurance Median: $152 (469%)

Cash: $170 (525% of Medicare)

Ins. Median: $152 (469% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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 469% of the Medicare baseline (a markup of 369%). 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
Health Net	$66 - $67	204%
Aetna	$70 - $209	216%
Caresource Mcr Adv	$70	216%
Humana	$70 - $209	216%
My True Advantage - All Plans	$70	216%
UnitedHealthcare	$70 - $182	216%
Blue Cross Blue Shield	$72 - $166	222%
Today'S Option Mcr Adv-All Plans	$72 - $73	222%
Viant Beech St Mcr Adv	$72 - $73	222%
Caresource Marketplace-All Other Plans	$112 - $113	346%
Cigna	$180 - $182	556%
Phcs-All Plans	$180 - $182	556%
Consumers Life Ins-All Plans	$203 - $205	627%
Coventry/First Health-All Plans	$203 - $205	627%
Sagamore-All Plans	$207 - $209	639%
Siho-All Plans	$207 - $209	639%
Multiplan-All Plans	$209 - $211	645%
Community Health Alliance-All Plans	$212 - $214	654%
Encore Health Services-All Plans	$221 - $223	682%

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 $170.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Rush Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.