CMS Price Transparency Data

Office visit, established patient (30-39 min)

Facility: Rush Memorial Hospital

Billing Code: 99214 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 99214
Insurance Median: $82
Cash Discount Price: $232
vs. Medicare Baseline: 0.60x Medicare

The contracted insurance negotiated median rate for a Office visit, established patient (30-39 min) at Rush Memorial Hospital is $82. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $232. Compared to the federal Medicare reimbursement reference rate of $135.6, this hospital’s rate is 0.60x the Medicare baseline. Located in 1300 N Main St, Rushville, IN.

Cash / Self-Pay

$232

Average discount available for prompt cash payment at this facility.

Insurance Median

$82

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$135.6

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $135.6 (100%)

Cash / Self-Pay: $232 (171%)

Insurance Median: $82 (60%)

Cash: $232 (171% of Medicare)

Ins. Median: $82 (60% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $135.6 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.

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
Coventry/First Health-All Plans	$17 - $600	13%
Health Net	$22 - $196	16%
Aetna	$23 - $614	17%
Caresource Mcr Adv	$23 - $207	17%
Humana	$23 - $614	17%
My True Advantage - All Plans	$23 - $207	17%
UnitedHealthcare	$23 - $534	17%
Blue Cross Blue Shield	$24 - $489	18%
Today'S Option Mcr Adv-All Plans	$24 - $213	18%
Viant Beech St Mcr Adv	$24 - $213	18%
Caresource Marketplace-All Other Plans	$37 - $331	27%
Cigna	$59 - $534	44%
Phcs-All Plans	$59 - $534	44%
Consumers Life Ins-All Plans	$66 - $600	49%
Sagamore-All Plans	$68 - $614	50%
Siho-All Plans	$68 - $614	50%
Community Health Alliance-All Plans	$69 - $627	51%
Multiplan-All Plans	$69 - $620	51%
Encore Health Services-All Plans	$72 - $654	53%

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 $232.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 99214.

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 99214.
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.