CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Woodlawn Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $133
Cash Discount Price: $136
vs. Medicare Baseline: 3.79x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Woodlawn Hospital is $133. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $136. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.79x the Medicare baseline. Located in 1400 E 9Th St, Rochester, IN.

Cash / Self-Pay

$136

Average discount available for prompt cash payment at this facility.

Insurance Median

$133

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: $136 (388%)

Insurance Median: $133 (379%)

Cash: $136 (388% of Medicare)

Ins. Median: $133 (379% 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 379% of the Medicare baseline (a markup of 279%). 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	$40 - $172	114%
Blue Cross Blue Shield	$40 - $181	114%
Caresource Mcaid Hip	$40	114%
Caresource Mcr Adv	$40	114%
Humana	$40 - $140	114%
Mdwise Mcaid Excel Hip	$40	114%
Mhs Exch Mrktplce-All Other Plans	$40	114%
Mhs Mcaid Hip	$40	114%
UnitedHealthcare	$40 - $181	114%
Mhs Mcr Adv	$41	117%
Caresource Exch - All Other Plans	$52	148%
Ambetter / Centene	$53	151%
Partners Direct Health-All Plans	$123	351%
Cigna	$130 - $154	371%
Parkview Health Plans-All Plans	$136	388%
Sagamore All Other Grps - All Other Plans	$152	433%
Encore Comm-All Plans	$154	439%
Phcs/Multiplan-All Plans	$168	479%
Community Health Alliance-All Plans	$172	490%
Caresource Mcaid Hww	$181	516%
Mhs Mcaid Hcc	$181	516%
Mhs Mcaid Hhw	$181	516%

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 $136.
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 Woodlawn 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.