CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Gundersen St Josephs Hospital and Clinics

Billing Code: 97535 (CPT)

The BaseRate · fair price medium confidence

A fair price for this

$129

about 4.0× the $32 Medicare rate · typically $38–$188

modeled estimate · not a bill or quote

What this hospital charges insurers

$130

About the fair price

about $1 over the fair price · 4.1× Medicare

Medicare pays $32 Fair price $129 This hospital $130 Cash price $143 Hospital's list price $246

How we calculate the fair BaseRate →

How this hospital compares to other WI hospitals

Highest price of the 9 WI hospitals we have prices for — worth calling around.

Cheapest $23 Priciest $130

Black dot = this hospital, among the 9 WI hospitals with a price for this procedure. Full list below.

A fair price for a Occupational therapy (self-care training) is about $129 (about 4.0× the $32 Medicare rate). Gundersen St Josephs Hospital and Clinics charges insurers about $130, or about $143 in cash — about the fair price. Located in Hillsboro, WI.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Humana Kaiser Permanente

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$130 - $172	401%
Blue Cross Blue Shieldmajor	$74 - $170	228%
Aetnamajor	$234	722%
Cignamajor	$202	623%
Humanamajor	$209	645%
Amerigroup	$12	37%
Quartz	$134	414%
Security Health Plan	$48	148%
UCare	$128 - $197	395%
+ 4 smaller / regional plans	$74 - $209

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 143), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97535.

Insurance Before you use insurance

Call your insurance company to confirm Gundersen St Josephs Hospital and Clinics is in-network.
Ask your insurer whether prior approval is required for CPT code 97535.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Gundersen St Josephs Hospital and Clinics

Compare: Occupational therapy (self-care training) at other WI hospitals

Insurance negotiated median for the same procedure, sorted lowest first.