CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Mid-Columbia Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $89
Cash Discount Price: $68
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Mid-Columbia Medical Center is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $68. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.75x the Medicare baseline. Located in 1700 E 19Th Street, The Dalles, OR.

Cash / Self-Pay

$68

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $68 (210%)

Insurance Median: $89 (275%)

Cash: $68 (210% of Medicare)

Ins. Median: $89 (275% 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 275% of the Medicare baseline (a markup of 175%). 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	$32 - $453	99%
Community Hp Mcr Adv - All Plans	$32	99%
Moda Mcr Adv	$32	99%
Molina Mcr Adv	$32	99%
Tricare	$32	99%
Va Ccn Triwest - All Plans	$32	99%
Healthnet Mcr Adv	$33	102%
Humana	$34	105%
Molina - All Other Plans	$35	108%
Employee Health Plan - All Plans	$58	179%
Norocor - All Plans	$71	219%
Amerigroup Mcaid - All Plans	$74	228%
Coordinated Care Mcaid - All Plans	$74	228%
Molina Mcaid	$74	228%
UnitedHealthcare	$74 - $135	228%
Moda Health Plan - All Other Plans	$94	290%
Healthscape - All Plans	$114	352%
First Health - All Plans	$126	389%
Coventry - All Plans	$128	395%
Aetna	$131	404%
Pacific Source - All Plans	$131	404%
Cigna	$134	414%
First Choice - All Plans	$135	417%
Multiplan/Phcs - All Plans	$135	417%
Providence Ppo - All Plans	$135	417%
Trpn - Three Rivers - All Plans	$135	417%
Ahp - Americas Hlth Plan - All Plans	$138	426%
Devoted Mcr Adv - All Plans	$153	472%

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 $68.
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 Mid-Columbia Medical Center 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.