Occupational therapy (therapeutic activities)
Facility: Childrens Hospital of Wisconsin
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $135
- Cash Discount Price: $93
- vs. Medicare Baseline: 3.85x 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 385% of the Medicare baseline (a markup of 285%). 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 |
|---|---|---|
| My Choice Wisconsin | $33 - $37 | 94% |
| UnitedHealthcare | $33 - $129 | 94% |
| Chorus Community Health Plan | $34 | 97% |
| Managed Health Services | $36 | 103% |
| Molina Healthcare Of Wisconsin | $37 | 106% |
| Blue Cross Blue Shield | $38 - $161 | 108% |
| Icare | $41 | 117% |
| Froedtert Health | $118 - $144 | 336% |
| Medical College Of Wisconsin | $118 | 336% |
| Network Health Plan | $121 | 345% |
| Aspirus Health Plan | $127 | 362% |
| Common Ground Healthcare Cooperative | $127 - $144 | 362% |
| Trilogy Health Solutions | $127 - $144 | 362% |
| Wps Health Plan | $129 - $152 | 368% |
| Advocate Aurora Healthcare | $130 | 371% |
| Centivo | $132 | 376% |
| Health Partners | $132 - $149 | 376% |
| Employer Health Care Alliance Cooperative | $133 | 379% |
| Dean Health Plan | $135 | 385% |
| Group Health Cooperative Of Eau Claire | $135 | 385% |
| Oan Llc | $135 | 385% |
| Security Health Plan | $140 | 399% |
| Health Payment Systems | $143 | 408% |
| Praire States | $144 | 411% |
| Quartz Health Insurance | $144 | 411% |
| Sheboygan Employer'S Health Network | $144 | 411% |
| Mayo Clinic Health Solutions | $147 | 419% |
| Aetna | $149 - $151 | 425% |
| Bellin Thedacare | $152 | 433% |
| Cigna | $152 | 433% |
| Group Health Cooperative Of South Central Wisconsin | $152 | 433% |
| Prevea Health Network | $152 | 433% |
| Multiplan | $154 - $161 | 439% |
| Coventry Health Care | $161 | 459% |