CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Froedtert Memorial Lutheran Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $98
Cash Discount Price: $83
vs. Medicare Baseline: 3.02x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Froedtert Memorial Lutheran Hospital is $98. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $83. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.02x the Medicare baseline. Located in 9200 W Wisconsin Ave, Milwaukee, WI.

Cash / Self-Pay

$83

Average discount available for prompt cash payment at this facility.

Insurance Median

$98

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: $83 (256%)

Insurance Median: $98 (302%)

Cash: $83 (256% of Medicare)

Ins. Median: $98 (302% 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 302% of the Medicare baseline (a markup of 202%). 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	$31 - $329	96%
Community Care	$31	96%
Health Partners	$31 - $131	96%
Humana	$31	96%
Icare	$31	96%
Molina	$31	96%
Network Health Plan	$31 - $263	96%
Priority Health	$31	96%
Quartz	$31	96%
Security Health Plan	$31 - $167	96%
UnitedHealthcare	$31 - $384	96%
Upper Peninsula Health Plan	$31	96%
Aetna	$32 - $138	99%
Care Wisconsin/Mychoice	$32	99%
Wellcare	$32	99%
Centivo	$34 - $70	105%
Medical College Of Wisconsin	$37 - $70	114%
Chorus Community Health Plan	$44 - $83	136%
Froedtert South	$45 - $85	139%
Wisconsin Physician Services Statewide Alliance	$71 - $134	219%
Trilogy	$73 - $138	225%
Health Payment Systems	$74 - $140	228%
Cigna	$88 - $165	272%
Dean Health Plan	$90 - $170	278%
Group Health Cooperative	$90 - $170	278%
Healtheos	$90 - $170	278%
Multiplan/Private Healthcare Systems	$90 - $170	278%
Healthsmart	$94 - $176	290%
Wisconsin Physician Services	$96 - $180	296%
First Health Network	$98 - $183	302%
Sheboygan Employers Health Network	$298	920%

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 $83.
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 Froedtert Memorial Lutheran 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.