CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Astera Health

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $129
Cash Discount Price: $122
vs. Medicare Baseline: 3.98x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Astera Health is $129. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $122. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.98x the Medicare baseline. Located in 421 11Th Street Nw, Wadena, MN.

Cash / Self-Pay

$122

Average discount available for prompt cash payment at this facility.

Insurance Median

$129

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $122 (377%)

Insurance Median: $129 (398%)

Cash: $122 (377% of Medicare)

Ins. Median: $129 (398% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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 398% of the Medicare baseline (a markup of 298%). 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
Blue Plus Pmap [40002]	$34 - $5,128	105%
Ucare Pmap [30006]	$63 - $1,691	194%
Blue Cross Blue Shield	$69 - $5,128	213%
Health Partners [10045]	$69 - $5,128	213%
Medica Nonpmap [10056]	$69 - $13,477	213%
Primewest Non Pmap [30004]	$69 - $5,128	213%
Medica Pmap [10057]	$72 - $3,448	222%
Primewest Pmap [30003]	$72 - $3,448	222%
Ucare Non Pmap [30007]	$73 - $5,385	225%
Health Partners Pmap [10046]	$87	269%
Ucare Commercial [10705]	$120 - $129	370%
UnitedHealthcare	$128 - $134	395%
Multiplan	$138	426%
Sanford Health Plan [10120]	$147	454%
Aetna	$155 - $156	478%

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 $122.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Astera Health is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.