CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Fort Memorial Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $105
Cash Discount Price: $52
vs. Medicare Baseline: 3.24x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Fort Memorial Hospital is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $52. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.24x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$52

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $52 (160%)

Insurance Median: $105 (324%)

Cash: $52 (160% of Medicare)

Ins. Median: $105 (324% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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 324% of the Medicare baseline (a markup of 224%). 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
Blue Cross Blue Shield	$12 - $271	37%
Dean Health Plan	$12 - $105	37%
Medicaid / KanCare	$12	37%
Quartz	$12 - $162	37%
UnitedHealthcare	$12 - $120	37%
Managed Health Services	$13	40%
Humana	$32 - $113	99%
Molina	$33	102%
Veteran Evaluation Services	$51	157%
Aetna	$64 - $120	198%
Fort Care	$102	315%
Group Health Cooperative	$102 - $261	315%
Alliance	$114 - $115	352%
Mercycare	$118 - $119	364%
Trilogy	$139 - $141	429%
Cigna	$150 - $152	463%
Centivo	$288 - $300	889%

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 $52.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Fort Memorial Hospital is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.