CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Upland Hills Health

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $131
Cash Discount Price: $119
vs. Medicare Baseline: 3.74x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Upland Hills Health is $131. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $119. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.74x the Medicare baseline. Located in 800 Compassion Way, Dodgeville, WI.

Cash / Self-Pay

$119

Average discount available for prompt cash payment at this facility.

Insurance Median

$131

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: $119 (339%)

Insurance Median: $131 (374%)

Cash: $119 (339% of Medicare)

Ins. Median: $131 (374% 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 374% of the Medicare baseline (a markup of 274%). 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
UnitedHealthcare	$35 - $178	100%
Ghc Of Eau Claire	$47	134%
Ghc Of Sc Wi	$47 - $155	134%
Mhs	$47 - $64	134%
Blue Cross Blue Shield	$59 - $187	168%
Humana	$59 - $205	168%
Icare	$59 - $64	168%
Medical Associates	$59 - $90	168%
Security Health Plan	$59 - $64	168%
Quartz	$66 - $157	188%
Dean Health Plan	$102 - $159	291%
Alliance	$120 - $129	342%
Wps	$129 - $143	368%
Cigna	$158 - $190	451%
Multiplan	$186 - $201	530%

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 $119.
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 Upland Hills Health 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.