CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Gundersen Lutheran Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $97
Cash Discount Price: $61
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Gundersen Lutheran Medical Center is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $61. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.99x the Medicare baseline. Located in 1910 South Ave, La Crosse, WI.

Cash / Self-Pay

$61

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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: $61 (188%)

Insurance Median: $97 (299%)

Cash: $61 (188% of Medicare)

Ins. Median: $97 (299% 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 299% of the Medicare baseline (a markup of 199%). 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
Amerigroup	$12 - $41	37%
Blue Cross Blue Shield	$12 - $486	37%
Group Health Eau Claire	$12 - $146	37%
Group Health Of South Central	$12 - $130	37%
Icare	$12 - $41	37%
Iowa Total Care	$12	37%
Managed Health Service	$12	37%
Molina Health	$12	37%
UnitedHealthcare	$12 - $132	37%
Aetna	$41 - $154	127%
Medical Associates	$41 - $122	127%
Ucare	$41 - $130	127%
Medica	$54 - $124	167%
Dean Health Plan	$68	210%
Quartz	$69	213%
Health Partners	$81 - $143	250%
Midland Choice	$122	377%
Alliance	$127 - $173	392%
Claim Doc Llc	$130	401%
Wps Narrow Network	$131	404%
Cigna	$133	410%
Wps - Arise	$133	410%
Aspirus Arise Health	$134	414%
Allied National General	$138	426%
Preferred One	$138	426%
Wps Statewide	$138	426%
Coventry Health Care	$154	475%
Humana	$154	475%
Multiplan/Healtheos	$156	481%

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 $61.
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 Gundersen Lutheran Medical Center 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.