CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Gundersen Lutheran Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $76
Cash Discount Price: $61
vs. Medicare Baseline: 2.17x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Gundersen Lutheran Medical Center is $76. 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 $35.07, this hospital’s rate is 2.17x 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

$76

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: $61 (174%)

Insurance Median: $76 (217%)

Cash: $61 (174% of Medicare)

Ins. Median: $76 (217% 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 217% of the Medicare baseline (a markup of 117%). 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	$15 - $45	43%
Blue Cross Blue Shield	$15 - $486	43%
Group Health Eau Claire	$15 - $146	43%
Group Health Of South Central	$15 - $130	43%
Icare	$15 - $45	43%
Iowa Total Care	$15	43%
Managed Health Service	$15	43%
Molina Health	$15	43%
UnitedHealthcare	$15 - $132	43%
Aetna	$45 - $154	128%
Medical Associates	$45 - $122	128%
Ucare	$45 - $130	128%
Medica	$54 - $124	154%
Dean Health Plan	$68	194%
Quartz	$69	197%
Health Partners	$81 - $143	231%
Midland Choice	$122	348%
Alliance	$127 - $194	362%
Claim Doc Llc	$130	371%
Wps Narrow Network	$131	374%
Cigna	$133	379%
Wps - Arise	$133	379%
Aspirus Arise Health	$134	382%
Allied National General	$138	393%
Preferred One	$138	393%
Wps Statewide	$138	393%
Coventry Health Care	$154	439%
Humana	$154	439%
Multiplan/Healtheos	$156	445%

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: 97530.

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 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.