CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Crossing Rivers Health Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $147
Cash Discount Price: $155
vs. Medicare Baseline: 4.19x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Crossing Rivers Health Medical Center is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $155. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.19x the Medicare baseline. Located in 37868 Us Hwy 18, Prairie Du Chien, WI.

Cash / Self-Pay

$155

Average discount available for prompt cash payment at this facility.

Insurance Median

$147

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: $155 (442%)

Insurance Median: $147 (419%)

Cash: $155 (442% of Medicare)

Ins. Median: $147 (419% 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 419% of the Medicare baseline (a markup of 319%). 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 Mcr Adv	$65	185%
Blue Cross Blue Shield	$65 - $150	185%
Security Hlth Mcr Adv	$65	185%
UnitedHealthcare	$65	185%
Humana	$66 - $149	188%
Amerigroup Mcaid-All Other Plans	$74	211%
Iowa Total Care Mcaid-All Plans	$74	211%
Quartz - All Plans	$124	354%
Dean Health Plan - All Plans	$147	419%
Medica Comm - All Other Plans	$147	419%
Medica Hp Solutions	$147	419%
Security Hlth Comm - All Other Plans	$147	419%
Health Trad Hp - All Plans	$149	425%
Wea Provider Ntwrk - All Plans	$149	425%
Cigna	$150	428%
First Health - All Plans	$150	428%
Geha - All Plans	$150	428%
Group Health Co-Op - All Plans	$150	428%
Health Partners - All Plans	$150	428%
Medical Associates Hp - All Plans	$150	428%
Preferred Health Choice - All Plans	$150	428%
Wps - All Plans	$150	428%

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 $155.
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 Crossing Rivers Health 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.