CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Saint Alphonsus Medical Center Ontario
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $31
- Cash Discount Price: $68
- vs. Medicare Baseline: 0.96x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Saint Alphonsus Medical Center Ontario is $31. 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 0.96x the Medicare baseline. Located in 351 Sw 9Th Street, Ontario, OR.
Cash / Self-Pay
$68
Average discount available for prompt cash payment at this facility.
Insurance Median
$31
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: $31 (96%)
Cash: $68 (210% of Medicare)
Ins. Median: $31 (96% 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Medicaid / KanCare | $18 - $31 | 56% |
| Ada County Jail Inmate Ins | $31 | 96% |
| Aetna | $31 - $98 | 96% |
| Ambetter / Centene | $31 | 96% |
| Amish Mennonite | $31 | 96% |
| Bcccp-Michigan | $31 | 96% |
| Bccp | $31 | 96% |
| Blue Cross Blue Shield | $31 - $88 | 96% |
| Bmc Healthnet | $31 | 96% |
| Breast Grant-Connecticut | $31 | 96% |
| California Health And Wellness | $31 | 96% |
| Cardinal Innovations Lme | $31 | 96% |
| Care Oregon Ohp | $31 | 96% |
| Cencal Health Plan | $31 | 96% |
| Cenpatico | $31 | 96% |
| Centurion Of Idaho | $31 | 96% |
| Chhuny | $31 | 96% |
| Childrens Comm Health Plan | $31 | 96% |
| Childrens Medical Services Title 19 | $31 | 96% |
| Cigna | $31 - $98 | 96% |
| Community Benefit Health | $31 | 96% |
| Community Care Behavorial Health | $31 | 96% |
| Community Health Choice | $31 | 96% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $31 | 96% |
| Dean Wi Badgercare | $31 | 96% |
| Delaware First Health | $31 | 96% |
| Delta Dental Nj | $31 | 96% |
| Dph Tb Program | $31 | 96% |
| Dscc | $31 | 96% |
| Eastpointe Lme | $31 | 96% |
| Family Health Network | $31 | 96% |
| Freedom First Healthcare | $31 | 96% |
| Ghc Scw Wi Badgercare | $31 | 96% |
| Harbor Health | $31 | 96% |
| Health Safety Net | $31 | 96% |
| Healthy Blue Ne | $31 | 96% |
| Hennepin Health | $31 | 96% |
| Humana | $31 - $92 | 96% |
| Id County Ada | $31 | 96% |
| Id County Canyon | $31 | 96% |
| Id County Cat Fund | $31 | 96% |
| Id County Payette | $31 | 96% |
| Idaho Womens Health Check | $31 | 96% |
| Indiana Breast Cervical Cancer | $31 | 96% |
| Inland Empire Health Plan | $31 | 96% |
| Intercommunity Health Ohp | $31 | 96% |
| Iowa Total Care | $31 | 96% |
| Jai Medical System | $31 | 96% |
| Kern Family Health Plan | $31 | 96% |
| Keystone First | $31 | 96% |
| Keystone First Chip | $31 | 96% |
| La Care Health Plan | $31 | 96% |
| Lakeland Care Inc | $31 | 96% |
| Managed Health Services - Indiana | $31 | 96% |
| Maryland Breast & Cervical Program | $31 | 96% |
| Maryland Healthy Smiles - Scion Dental | $31 | 96% |
| Maryland Physicians Care | $31 | 96% |
| Massachusetts Behavioral Health Partnership | $31 | 96% |
| Mdwise | $31 | 96% |
| Medi-Cal | $31 | 96% |
| Medi-Cal Healthnet | $31 | 96% |
| Medstar Dc Healthy Family | $31 | 96% |
| Medstar Md Health Choice | $31 | 96% |
| Mo Home State Health Plan | $31 | 96% |
| Molina Centennial Care | $31 | 96% |
| Nascentia Health Options | $31 | 96% |
| Nebraska Total Care | $31 | 96% |
| New York Cancer Services Program | $31 | 96% |
| Nextlevel Health | $31 | 96% |
| Oregon Screenwise | $31 | 96% |
| Pace Of Southwest Michigan | $31 | 96% |
| Paramount Advantage | $31 | 96% |
| Parkland Community Health Plan | $31 | 96% |
| Partners Behavioral Lme | $31 | 96% |
| Peach State Healthplan | $31 | 96% |
| Presbyterian Centennial Care | $31 | 96% |
| Prestige Health Choice | $31 | 96% |
| Priority Partners | $31 | 96% |
| Rx 340B Pass Along | $31 | 96% |
| Rx Assistance/Rx Manufacturer Assistance 0 Copay | $31 | 96% |
| Rx Medi-Cal | $31 | 96% |
| Rx Meridian Rx | $31 | 96% |
| Sandhills Center Lme | $31 | 96% |
| Screening For Life | $31 | 96% |
| Sunshine State Health Plan | $31 | 96% |
| Superior Health | $31 | 96% |
| Tenncare | $31 | 96% |
| Texas Children'S Health Plan | $31 | 96% |
| Trillium Community Ohp | $31 | 96% |
| Tufts Health Public Plans | $31 | 96% |
| UnitedHealthcare | $31 - $100 | 96% |
| Vaya Health Lme | $31 | 96% |
| Wellsense Health Plan | $31 | 96% |
| Wi Womens Wellness | $31 | 96% |
| Medicare (plans) | $32 - $34 | 99% |
| American Health Advantage Of Idaho | $33 | 102% |
| Blue Benefit Administrators Of Massachusetts | $51 | 157% |
| Blue Care Network | $51 | 157% |
| Blue Distinction Transplant | $51 | 157% |
| Blue Shield - Ca | $51 | 157% |
| Blue Shield - Id (Regence) | $51 | 157% |
| Blue Shield - Ny Highmark Northeastern | $51 | 157% |
| Blue Shield - Ny Highmark Western | $51 | 157% |
| Blue Shield - Pa (Highmark) | $51 | 157% |
| Blue Shield - Wa (Regence) | $51 | 157% |
| Healthcare Management Admin | $55 | 170% |
| Moda Health | $60 - $101 | 185% |
| Selecthealth | $61 - $94 | 188% |
| Mountain Health Co-Op | $62 | 191% |
| Pacificsource Health Plans | $62 | 191% |
| Allegiance | $79 | 244% |
| Correctional Health Partners | $81 | 250% |
| Columbia Health Network | $83 | 256% |
| Webtpa | $86 - $94 | 265% |
| Healthnet | $87 | 269% |
| Allied National Global Care | $94 | 290% |
| Asrm - Reliance Standard Life Insurance | $94 | 290% |
| Christian Care Ministry | $94 | 290% |
| Dean Health | $94 | 290% |
| Fallon Health | $94 | 290% |
| Family Life Insurance Company | $94 | 290% |
| First Choice Health | $94 | 290% |
| Ghc Scw | $94 | 290% |
| International Benefit Administrators | $94 | 290% |
| Lifetime Benefit Solutions | $94 | 290% |
| Manhattan Life | $94 | 290% |
| Pai | $94 | 290% |
| Pan-American Life | $94 | 290% |
| Paramount Hmo | $94 | 290% |
| Phcs | $94 | 290% |
| Trinity Health Share | $94 | 290% |
| Lifewise | $97 | 299% |
| Allied Benefit Systems | $98 | 302% |
| Ameriben | $98 | 302% |
| Asr Health Benefits | $98 | 302% |
| Christian Brother Services | $98 | 302% |
| Geha | $98 - $100 | 302% |
| Healthez | $98 | 302% |
| Luminare Health (Detroit) | $98 | 302% |
| Priority Health | $98 | 302% |
| Rural Carrier Health Benefit Plan | $98 | 302% |
| First Health | $99 | 306% |
| Medi Share | $99 | 306% |
| Providence | $99 | 306% |