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 |
|---|---|---|
| Medica (Under Dean) | $108 | 308% |
| Alliance PPO | $108 | 308% |
| Dean PPO Hmo/Pos | $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% |
| Unity Health Plan and Unity Quartz(Hmo/Pos) | $157 | 448% |
| Molina (Fka Care Wisconsin) | $157 | 448% |
| Wellcare McR | $157 | 448% |
| Quartz (Self Funded) / Unity Health Plan (Hmo/Pos) | $157 | 448% |
| Blue Cross Blue Shield | $157 | 448% |
| All Savers | $157 | 448% |
| Network Health - Commercial | $157 | 448% |
| Humana | $157 | 448% |
| VA - Primary Only - Authorization Required | $157 | 448% |
| Centivo Broad | $157 | 448% |
| Children's Communty Health Plan(Cchp) | $157 | 448% |
| Network Health - Aca | $157 | 448% |
| Centivo Intermediate/Median | $157 | 448% |
| Security Health Plan - Advocare | $157 | 448% |
| Managed Health Services (Mhs) | $157 | 448% |
| Medicaid / KanCare | $157 | 448% |
| Community Care, Inc | $157 | 448% |
| Icare McD | $157 | 448% |
| Together With Cchp | $157 | 448% |
| Medicare (plans) | $157 | 448% |
| Centivo Narrow/Value | $157 | 448% |
| Cigna | $157 | 448% |