CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Oak Valley Hospital District

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $94
Cash Discount Price: $117
vs. Medicare Baseline: 2.90x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Oak Valley Hospital District is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $117. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.90x the Medicare baseline. Located in 350 S Oak Ave, Oakdale, CA.

Cash / Self-Pay

$117

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

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: $117 (361%)

Insurance Median: $94 (290%)

Cash: $117 (361% of Medicare)

Ins. Median: $94 (290% 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 290% of the Medicare baseline (a markup of 190%). 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 Cross Blue Shield	$8 - $205	25%
Healthnet Medi-Cal Ip/Op Only	$8	25%
Kaiser Medi-Cal Ip/Op Only	$8	25%
Medi-Cal Ip/Op Only	$8	25%
Hp Of San Joaquin Ip/Op Only-All Plans	$9	28%
Alignment Op Only Ip/Op Only-All Plans	$34	105%
Humana	$34	105%
Kaiser Mcr Adv Ip/Op Only	$34	105%
Scan Health Plan Ip/Op Only-All Plans	$35	108%
Imperial Health Ip/Op Only-All Plans	$38	117%
Healthnet Comm Op Only Ip/Op Only-All Other Plans	$57 - $135	176%
UnitedHealthcare	$58 - $137	179%
Kaiser Comm Ip/Op Only-All Other Plans	$60 - $141	185%
Cigna	$65 - $153	201%
Blue Shield Epn Ip/Op Only	$67 - $158	207%
Aetna	$83 - $194	256%
Blue Shield/Bcout Ip/Op Only-All Other Plans	$87 - $205	269%

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 $117.
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 Oak Valley Hospital District 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.