Occupational therapy (therapeutic activities)
Facility: Rehabilitation Hospital of Wisconsin
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $157
- Cash Discount Price: $157
- vs. Medicare Baseline: 4.48x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 448% of the Medicare baseline (a markup of 348%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Alliance Ppo | $108 | 308% |
| Dean Ppo Hmo/Pos | $108 | 308% |
| Medica (Under Dean) | $108 | 308% |
| UnitedHealthcare | $110 - $157 | 314% |
| Trilogy Ppo | $113 - $157 | 322% |
| Wps "Insurance" Ppo | $115 | 328% |
| Phcs Savility | $118 | 336% |
| Hps Solutions Ppo | $119 | 339% |
| Aetna | $123 - $157 | 351% |
| Health Eos Poc | $126 | 359% |
| Coventry/First Health Ppo | $129 | 368% |
| Hps (Other) | $129 | 368% |
| Health Eos Multiplan | $134 | 382% |
| Phcs / Multiplan | $145 | 413% |
| All Savers | $157 | 448% |
| Blue Cross Blue Shield | $157 | 448% |
| Centivo Broad | $157 | 448% |
| Centivo Intermediate/Median | $157 | 448% |
| Centivo Narrow/Value | $157 | 448% |
| Children'S Communty Health Plan(Cchp) | $157 | 448% |
| Cigna | $157 | 448% |
| Community Care, Inc | $157 | 448% |
| Humana | $157 | 448% |
| Icare Mcd | $157 | 448% |
| Managed Health Services (Mhs) | $157 | 448% |
| Medicaid / KanCare | $157 | 448% |
| Medicare (plans) | $157 | 448% |
| Molina (Fka Care Wisconsin) | $157 | 448% |
| Network Health - Aca | $157 | 448% |
| Network Health - Commercial | $157 | 448% |
| Quartz (Self Funded) / Unity Health Plan (Hmo/Pos) | $157 | 448% |
| Security Health Plan - Advocare | $157 | 448% |
| Together With Cchp | $157 | 448% |
| Unity Health Plan And Unity Quartz(Hmo/Pos) | $157 | 448% |
| Va - Primary Only - Authorization Required | $157 | 448% |
| Wellcare Mcr | $157 | 448% |