CMS Price Transparency Data

Office visit, established patient (20-29 min)

Facility: Rush Memorial Hospital

Billing Code: 99213 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99213
Insurance Median: $196
Cash Discount Price: $210
vs. Medicare Baseline: 2.06x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (20-29 min) at Rush Memorial Hospital is $196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $210. Compared to the federal Medicare reimbursement reference rate of $95.19, this hospital’s rate is 2.06x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$210

Average discount available for prompt cash payment at this facility.

Insurance Median

$196

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$95.19

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $95.19 (100%)

Cash / Self-Pay: $210 (221%)

Insurance Median: $196 (206%)

Cash: $210 (221% of Medicare)

Ins. Median: $196 (206% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $95.19 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 206% of the Medicare baseline (a markup of 106%). 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
Aetna	$48 - $500	50%
Consumers Life Ins-All Plans	$48 - $489	50%
UnitedHealthcare	$48 - $435	50%
Cigna	$51 - $435	54%
Health Net	$51 - $160	54%
Phcs-All Plans	$52 - $435	55%
Humana	$61 - $500	64%
Caresource Marketplace-All Other Plans	$74 - $269	78%
Blue Cross Blue Shield	$96 - $398	101%
Coventry/First Health-All Plans	$104 - $489	109%
Encore Health Services-All Plans	$109 - $532	115%
Siho-All Plans	$109 - $500	115%
Multiplan-All Plans	$122 - $505	128%
Caresource Mcr Adv	$127 - $168	133%
My True Advantage - All Plans	$127 - $168	133%
Today'S Option Mcr Adv-All Plans	$131 - $173	138%
Viant Beech St Mcr Adv	$131 - $173	138%
Sagamore-All Plans	$378 - $500	397%
Community Health Alliance-All Plans	$386 - $511	406%

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 $210.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99213.

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 99213.
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.