CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Marshfield Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $157
Cash Discount Price: $162
vs. Medicare Baseline: 4.48x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Marshfield Medical Center is $157. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $162. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.48x the Medicare baseline. Located in 611 St Joseph Ave, Marshfield, WI.

Cash / Self-Pay

$162

Average discount available for prompt cash payment at this facility.

Insurance Median

$157

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: $162 (462%)

Insurance Median: $157 (448%)

Cash: $162 (462% of Medicare)

Ins. Median: $157 (448% 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 448% of the Medicare baseline (a markup of 348%). 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
Family Health Center (Fhc)	$86	245%
Amish/Mennonite	$94	268%
Sanford Health Plan	$94	268%
The Alliance	$119 - $143	339%
Security Health Plan (Shp)	$120 - $177	342%
Blue Cross Blue Shield	$130 - $150	371%
Group Health Cooperative Of Eau Claire	$140 - $157	399%
Besse Forest Products	$145	413%
Molina Healthcare Of Wi	$145	413%
Rice Lake School District	$145	413%
Wps Health Insurance	$151 - $165	431%
Trilogy	$154 - $164	439%
UnitedHealthcare	$156	445%
Medica Of Wi	$159 - $162	453%
Cigna	$161	459%
Healtheos By Multiplan Inc.	$161 - $162	459%
Corvel	$162	462%
First Health	$162	462%
Health Partners	$162	462%
Three Rivers Provider Network (Trpn)	$162	462%
Coventry	$164	468%
Health Smart	$164	468%
Rising Medical Work Comp	$166	473%

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 $162.
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 Marshfield Medical Center 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.