CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Marshfield Medical Center - Beaver Dam (Mmc-Bd)

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $128
Cash Discount Price: $143
vs. Medicare Baseline: 3.95x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Marshfield Medical Center - Beaver Dam (Mmc-Bd) is $128. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $143. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.95x the Medicare baseline. Located in 707 S University Ave, Beaver Dam, WI.

Cash / Self-Pay

$143

Average discount available for prompt cash payment at this facility.

Insurance Median

$128

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: $143 (441%)

Insurance Median: $128 (395%)

Cash: $143 (441% of Medicare)

Ins. Median: $128 (395% 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 395% of the Medicare baseline (a markup of 295%). 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
The Alliance	$76	235%
Security Health Plan (Shp)	$78 - $87	241%
Amish/Mennonite	$82	253%
Quartz	$86	265%
Wps Health Insurance	$93 - $101	287%
Cigna	$102 - $111	315%
Health Payment Systems	$104	321%
Humana	$118 - $134	364%
Group Health Cooperative Of Eau Claire	$123 - $142	380%
Network Health Plan	$125	386%
First Health	$128	395%
Molina Healthcare Of Wi	$128	395%
Trilogy	$135	417%
Healtheos By Multiplan Inc.	$140 - $142	432%
Health Partners	$142	438%
Coventry	$144	444%
UnitedHealthcare	$253	781%
Blue Cross Blue Shield	$318 - $477	981%

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 $143.
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 Marshfield Medical Center - Beaver Dam (Mmc-Bd) 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.