CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adventist Health Ukiah Valley

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $71
Cash Discount Price: $31
vs. Medicare Baseline: 2.19x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health Ukiah Valley is $71. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $31. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.19x the Medicare baseline. Located in 275 Hospital Drive, Ukiah, CA.

Cash / Self-Pay

$31

Average discount available for prompt cash payment at this facility.

Insurance Median

$71

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: $31 (96%)

Insurance Median: $71 (219%)

Cash: $31 (96% of Medicare)

Ins. Median: $71 (219% 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 219% of the Medicare baseline (a markup of 119%). 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
Kaiser Medi-Cal	$5 - $8	15%
Medi-Cal	$5 - $8	15%
Aetna	$24 - $156	74%
Blue Shield Mcr Adv	$34	105%
Kaiser Mcr Adv	$34	105%
Tricare	$34	105%
UnitedHealthcare	$34 - $190	105%
Ah Employee Health Plan - All Plans	$38 - $61	117%
Cigna	$43 - $177	133%
Blue Shield Epn-All Other Plans	$45 - $290	139%
Blue Shield Non-Epn	$48 - $297	148%
Western Growers-All Plans	$49 - $309	151%
Healthnet-All Plans	$50 - $130	154%
Mendocino Lcc District-All Plans	$55 - $148	170%
Blue Cross Blue Shield	$66 - $634	204%
Kaiser-All Other Plans	$67 - $182	207%
Three Rivers-All Plans	$76 - $204	235%
Foundation For Medical Care-All Plans	$170	525%
Networks By Design-All Plans	$182	562%
Phcs Multiplan-All Plans	$182	562%
Interplan-All Plans	$186	574%
Beech Street-All Plans	$193	596%
Choice Care-All Plans	$193	596%
Health Mgmt Network-All Plans	$193	596%

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 $31.
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 Adventist Health Ukiah Valley 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.