CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: St Charles Medical Center Prineville
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $56
- Cash Discount Price: $113
- vs. Medicare Baseline: 1.73x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at St Charles Medical Center Prineville is $56. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $113. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.73x the Medicare baseline. Located in 384 Se Combs Flat Road, Prineville, OR.
Cash / Self-Pay
$113
Average discount available for prompt cash payment at this facility.
Insurance Median
$56
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: $113 (349%)
Insurance Median: $56 (173%)
Cash: $113 (349% of Medicare)
Ins. Median: $56 (173% 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.
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 |
|---|---|---|
| Pacificsource Community Solutions [525] | $27 - $30 | 83% |
| Aetna | $37 - $139 | 114% |
| Ageright Advantage [142] | $37 - $45 | 114% |
| Champ Va [700] | $37 - $45 | 114% |
| Cigna | $37 - $101 | 114% |
| Covid19 Hrsa Uninsured Testing And Treatment Fund | $37 - $45 | 114% |
| Devoted Health Inc [145] | $37 - $45 | 114% |
| Health Market Care Assured [134] | $37 - $45 | 114% |
| Health Net Med Adv [135] | $37 - $45 | 114% |
| Humana | $37 - $45 | 114% |
| Indian Health [704] | $37 - $45 | 114% |
| Kaiser Permanente Med Adv [136] | $37 - $45 | 114% |
| Law Enforcement [701] | $37 - $79 | 114% |
| Medicare (plans) | $37 - $52 | 114% |
| Samaritan Health Plan Med Adv [141] | $37 - $45 | 114% |
| Unicare [133] | $37 - $45 | 114% |
| UnitedHealthcare | $37 - $148 | 114% |
| Veterans [706] | $37 - $45 | 114% |
| Wellcare [132] | $37 - $45 | 114% |
| Otj Dept Of Labor Federal Emp [652] | $40 | 123% |
| Otj Us Department Of Labor [669] | $40 | 123% |
| Tricare | $40 - $49 | 123% |
| Blue Cross Blue Shield | $41 - $119 | 127% |
| Advanced Health [534] | $46 - $56 | 142% |
| Allcare Health Plan [538] | $46 - $56 | 142% |
| Cascade Health Alliance [532] | $46 - $56 | 142% |
| Columbia Pacific Coordinated Care Llc [539] | $46 - $56 | 142% |
| Health Share Care Oregon [526] | $46 - $56 | 142% |
| Health Share Kaiser [543] | $46 - $56 | 142% |
| Health Share Ohsu Ohp [552] | $46 - $56 | 142% |
| Health Share Providence [548] | $46 - $56 | 142% |
| Health Share [537] | $46 - $56 | 142% |
| Intercommunity Health [530] | $46 - $56 | 142% |
| Jackson Care Connect [542] | $46 - $56 | 142% |
| Medicaid / KanCare | $46 - $56 | 142% |
| Primary Health Of Jospehine County Llc [547] | $46 - $56 | 142% |
| Umpqua Health [533] | $46 - $56 | 142% |
| Willamette Valley Community Health [536] | $46 - $56 | 142% |
| Yamhill County Coordinated Care Org [550] | $46 - $56 | 142% |
| Pacificsource [345] | $53 - $88 | 164% |
| Kaiser Permanente [334] | $60 - $139 | 185% |
| Auto Allstate Insurance [602] | $65 | 201% |
| Auto American Family Insurance [603] | $65 | 201% |
| Auto Country Insurance Claims [604] | $65 | 201% |
| Auto Dairyland Insurance [617] | $65 | 201% |
| Auto Farmers [605] | $65 | 201% |
| Auto Geico Claims Oregon [606] | $65 | 201% |
| Auto Hartford [612] | $65 | 201% |
| Auto Liberty Mutual Auto Ins [613] | $65 | 201% |
| Auto Mutual Of Enumclaw [610] | $65 | 201% |
| Auto Nationwide Allied Insuranc [601] | $65 | 201% |
| Auto Oregon Mutual [614] | $65 | 201% |
| Auto Progressive [608] | $65 | 201% |
| Auto Safeco Concentra [600] | $65 | 201% |
| Auto State Farm Claims [609] | $65 | 201% |
| Auto Sublimity Insurance [616] | $65 | 201% |
| Auto Travelers Insurance [615] | $65 | 201% |
| Auto Usaa [611] | $65 | 201% |
| Generic Auto [649] | $65 | 201% |
| Generic Workers Comp [699] | $65 | 201% |
| Moda [310] | $65 - $121 | 201% |
| Otj Broadspire Services [670] | $65 | 201% |
| Otj Ccmsi [618] | $65 | 201% |
| Otj Chartis Claims [650] | $65 | 201% |
| Otj City County Ins Services [662] | $65 | 201% |
| Otj Corvel [676] | $65 | 201% |
| Otj Esis West Wc Claims [653] | $65 | 201% |
| Otj Gallagher Bassett [654] | $65 | 201% |
| Otj Hartford [655] | $65 | 201% |
| Otj Intermountain Claims Inc [666] | $65 | 201% |
| Otj Liberty Mutual Wausau Underwriters [671] | $65 | 201% |
| Otj Penser No American [663] | $65 | 201% |
| Otj Pinnacle Risk Mgmt [661] | $65 | 201% |
| Otj Saif [667] | $65 | 201% |
| Otj Sedgwick Cms [660] | $65 | 201% |
| Otj Sedgwick [668] | $65 | 201% |
| Otj Travelers Insurance [672] | $65 | 201% |
| Otj Tristar [673] | $65 | 201% |
| Providence Health Plan [347] | $65 - $140 | 201% |
| Us Benefits [326] | $83 - $101 | 256% |
| Bridgespan [342] | $101 | 312% |
| Rocky Mountain Administrators [405] | $105 - $128 | 324% |
| Rx Internal [4100003] | $108 - $131 | 333% |
| First Choice Health [317] | $114 - $139 | 352% |
| Samaritan [376] | $114 - $139 | 352% |
| Meritain Health [300] | $115 - $139 | 355% |
| Asuris Northwest Health [202] | $119 | 367% |
| Healthcare Management Admin [201] | $119 | 367% |
| Regence Group Administrators [203] | $119 | 367% |
| Health Net [340] | $124 - $150 | 383% |
| Administrative Concepts Inc [402] | $129 - $157 | 398% |
| First Health [339] | $129 - $157 | 398% |
| Manhattan Life Insurance Company [379] | $129 - $157 | 398% |
| Philadelphia American Life Insurance Company [395] | $129 - $157 | 398% |
| Planned Administrators Inc [375] | $129 - $157 | 398% |