CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Memorial Mission Hospital and Asheville Surgery Ce

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $47
Cash Discount Price: $145
vs. Medicare Baseline: 1.45x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Memorial Mission Hospital and Asheville Surgery Ce is $47. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $145. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.45x the Medicare baseline. Located in 509 Biltmore Ave, Asheville, NC.

Cash / Self-Pay

$145

Average discount available for prompt cash payment at this facility.

Insurance Median

$47

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: $145 (448%)

Insurance Median: $47 (145%)

Cash: $145 (448% of Medicare)

Ins. Median: $47 (145% 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.

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 Cross Blue Shield	$23 - $28	71%
Amerihealth	$24 - $29	74%
Partners Health Management	$24 - $30	74%
United	$24 - $91	74%
Vaya Health	$24 - $30	74%
Wellcare	$24 - $32	74%
Apex Health	$25 - $31	77%
Alignment Health	$27 - $31	83%
United Behavioral Health	$27 - $31	83%
Aetna	$28 - $112	86%
Humana	$28 - $32	86%
Provider Partners Health Plan	$29 - $33	90%
Pruitthealth Premier	$29 - $33	90%
Cigna	$30 - $77	93%
Healthteam Advantage	$30 - $34	93%
Troy Healthcare	$30 - $34	93%
Amerihealth Caritas	$31 - $73	96%
Longevity Health Plan	$33 - $37	102%
Oscar	$45 - $55	139%
Caresource	$56 - $68	173%
Medcost	$71 - $131	219%
Magellan	$76 - $93	235%
Magellan Behavioral Health	$76 - $93	235%
Multiplan	$101 - $123	312%
Avalon Administrative Services	$108 - $131	333%
Prime Health	$111 - $139	343%

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 $145.
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 Memorial Mission Hospital and Asheville Surgery Ce 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.