CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adventist Health Portland

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $108
Cash Discount Price: $59
vs. Medicare Baseline: 3.33x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health Portland is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $59. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.33x the Medicare baseline. Located in 10123 Se Market Street, Portland, OR.

Cash / Self-Pay

$59

Average discount available for prompt cash payment at this facility.

Insurance Median

$108

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: $59 (182%)

Insurance Median: $108 (333%)

Cash: $59 (182% of Medicare)

Ins. Median: $108 (333% 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 333% of the Medicare baseline (a markup of 233%). 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
Ods - All Plans	$28	86%
Care Oregon - All Plans	$29	90%
Kaiser Mcr Adv	$34	105%
Humana	$35 - $37	108%
Moda Mcr Adv	$37	114%
UnitedHealthcare	$37 - $110	114%
Healthnet Mcr Adv	$40	123%
Ah Employee Health Plan - All Plans	$62	191%
Workers Comp	$63	194%
Moda Conn Oebb/Syn Pebb	$69	213%
Moda Affinity - All Other Plans	$79	244%
Kaiser - All Other Plans	$90	278%
Bc Premera First - All Plans	$92	284%
Regence Ohsu Plus	$97	299%
Healthnet Hmo/Pos - All Other Plans	$104	321%
Healthnet Epo/Pos/Ppo	$105	324%
Regence - All Other Plans	$107	330%
Moda Select	$108	333%
Worldventure - All Plans	$110	340%
Providence Hp - All Plans	$119	367%
Regence Preferred Mcr Adv	$119	367%
Pacific Source Comm - All Plans	$121	373%
Moda Connexus	$122	377%
Cigna	$124	383%
First Choice - All Plans	$127	392%
Moda Synergy	$129	398%
Multiplan - All Plans	$137	423%
Phcs - All Plans	$137	423%
Regence Mcr Adv	$139	429%
Aetna	$141	435%
First Health-Coventry - All Plans	$146	451%
National Provider Network - All Plans	$161	497%
Health Payors Organization Ltd- All Plans	$165	509%
Healthcare Resources - All Plans	$205	633%
Moda Ohsu Ppo/Epo/Hmc	$329	1015%

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 $59.
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 Portland 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.