CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: HSHS St Clare Memorial Hospital

Billing Code: 97530 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$80

about 2.3× the $35 Medicare rate · typically $43–$190

modeled estimate · not a bill or quote

What this hospital charges insurers

$145

Well above the fair price

about $65 over the fair price · 4.1× Medicare

Medicare pays $35 Fair price $80 This hospital $145 Cash price $96 Hospital's list price $145

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $30 Priciest $145

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Occupational therapy (therapeutic activities) is about $80 (about 2.3× the $35 Medicare rate). HSHS St Clare Memorial Hospital charges insurers about $145, or about $96 in cash — well above the fair price. Located in Oconto Falls, WI.

This price is above the fair BaseRate — you may be able to pay less

Ask the hospital for the cash / self-pay price, check whether you qualify for financial assistance, or negotiate the bill down toward the fair price of about $80. Many patients pay well below the first number they’re quoted — the checklists below walk you through it.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$35 - $145	100%
Blue Cross Blue Shieldmajor	$33 - $145	94%
Aetnamajor	$35 - $145	100%
Cignamajor	$91	259%
Humanamajor	$35 - $123	100%
Health Net	$145	413%
Meridian	$33	94%
Molina	$35 - $72	100%
Security Health Plan	$35 - $93	100%
+ 16 smaller / regional plans	$33 - $145

Government programs also on file: Medicaid.

Excludes 6 rental-network / third-party entries (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 96), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97530.

Insurance Before you use insurance

Call your insurance company to confirm HSHS St Clare Memorial Hospital is in-network.
Ask your insurer whether prior approval is required for CPT code 97530.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at HSHS St Clare Memorial Hospital

Compare: Occupational therapy (therapeutic activities) at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.