CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Rush Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $168
Cash Discount Price: $188
vs. Medicare Baseline: 4.79x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Rush Memorial Hospital is $168. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $188. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.79x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$188

Average discount available for prompt cash payment at this facility.

Insurance Median

$168

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: $188 (536%)

Insurance Median: $168 (479%)

Cash: $188 (536% of Medicare)

Ins. Median: $168 (479% 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 479% of the Medicare baseline (a markup of 379%). 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	$74	211%
Caresource Mcr Adv	$77 - $78	220%
My True Advantage - All Plans	$77 - $78	220%
UnitedHealthcare	$77 - $200	220%
Aetna	$78 - $231	222%
Humana	$78 - $231	222%
Blue Cross Blue Shield	$80 - $184	228%
Today'S Option Mcr Adv-All Plans	$80	228%
Viant Beech St Mcr Adv	$80	228%
Caresource Marketplace-All Other Plans	$124	354%
Cigna	$200	570%
Phcs-All Plans	$200	570%
Consumers Life Ins-All Plans	$225 - $226	642%
Coventry/First Health-All Plans	$225 - $226	642%
Sagamore-All Plans	$230 - $231	656%
Siho-All Plans	$230 - $231	656%
Multiplan-All Plans	$232 - $233	662%
Community Health Alliance-All Plans	$235 - $236	670%
Encore Health Services-All Plans	$245 - $246	699%

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 $188.
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 Rush 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.