CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Fort Memorial Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $116
Cash Discount Price: $53
vs. Medicare Baseline: 3.31x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Fort Memorial Hospital is $116. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.31x the Medicare baseline. Located in 611 Sherman Ave E, Fort Atkinson, WI.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$116

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: $53 (151%)

Insurance Median: $116 (331%)

Cash: $53 (151% of Medicare)

Ins. Median: $116 (331% 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 331% of the Medicare baseline (a markup of 231%). 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	$15 - $271	43%
Dean Health Plan	$15 - $108	43%
Medicaid / KanCare	$15	43%
Quartz	$15 - $166	43%
UnitedHealthcare	$15 - $124	43%
Managed Health Services	$16	46%
Humana	$36 - $117	103%
Molina	$36	103%
Veteran Evaluation Services	$58	165%
Aetna	$65 - $123	185%
Group Health Cooperative	$105 - $263	299%
Alliance	$116 - $118	331%
Fort Care	$118	336%
Mercycare	$121 - $122	345%
Trilogy	$143 - $144	408%
Cigna	$154 - $156	439%
Centivo	$288 - $300	821%

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 $53.
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 Fort Memorial 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.