CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Riverside Community Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $34
Cash Discount Price: $304
vs. Medicare Baseline: 1.05x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Riverside Community Hospital is $34. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $304. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.05x the Medicare baseline. Located in 4445 Magnolia Avenue, Riverside, CA.

Cash / Self-Pay

$304

Average discount available for prompt cash payment at this facility.

Insurance Median

$34

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: $304 (938%)

Insurance Median: $34 (105%)

Cash: $304 (938% of Medicare)

Ins. Median: $34 (105% 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.

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
Bristol Hospice	$24 - $27	74%
Aetna	$30 - $55	93%
Alignment Health Plan	$30 - $34	93%
Blue Cross Blue Shield	$30 - $34	93%
Brand New Day	$30 - $34	93%
Central Health Plan	$30 - $34	93%
Clever Care Of Golden State	$30 - $34	93%
Easy Choice Health Plan	$30 - $34	93%
Heritage Provider Network	$30 - $47	93%
Humana	$30 - $34	93%
Redlands Community Hospital	$30 - $34	93%
Riverside Medical Clinic	$30 - $41	93%
Riverside Physician	$30 - $34	93%
Scan Health Plan	$30 - $34	93%
Triwest Healthcare Alliance	$30 - $34	93%
UnitedHealthcare	$30 - $34	93%
Care1St Health Plan	$31 - $35	96%
United	$31 - $80	96%
Blue Shield	$32 - $89	99%
Health Net	$34 - $68	105%
Corvel Corporation	$35 - $40	108%
Healthsmart	$36 - $243	111%
Next	$36 - $243	111%
Medcare Partners	$46	142%
Inland Empire Health Plan	$51 - $58	157%
Bright Health	$120	370%
First Health	$134 - $273	414%
American Health System	$137	423%
Multiplan	$243 - $258	750%

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 $304.
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 Riverside Community Hospital 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.