CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Paradise Valley Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $36
Cash Discount Price: $36
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Paradise Valley Hospital is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.11x the Medicare baseline. Located in 2400 East 4Th St, National City, CA.

Cash / Self-Pay

$36

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $36 (111%)

Insurance Median: $36 (111%)

Cash: $36 (111% of Medicare)

Ins. Median: $36 (111% 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
Aetna	$5 - $46	15%
Blue Sheid Of Promise	$5	15%
County Of San Diego	$5	15%
Golden Physicians Medical Group	$5 - $45	15%
Health Excel Ins	$5 - $36	15%
Heritage Provider Netwrok	$5 - $47	15%
Molina	$5 - $36	15%
Traditional Medi-Cal	$5	15%
UnitedHealthcare	$5 - $36	15%
Community Health Group	$6 - $36	19%
Health Net Of Ca	$6 - $53	19%
Blue Shield Of Ca, Va	$36	111%
Brand New Day	$36 - $54	111%
Ca Foundation For Medical Care	$36	111%
Central Health	$36	111%
Choice Physicians Network	$36	111%
Clever Care Of Golden State, Inc	$36	111%
Managed Health Network	$36	111%
Medicare (plans)	$36	111%
Renal Payer Solutions	$36	111%
Tricare	$36	111%
Usa Senior Care Network	$36	111%
Verda Health Plan	$36	111%
Imperial Health Plan Of Ca	$38	117%
Health Net Federal Service (Cdcr)	$45	139%
Veterans Evaluation Services	$45	139%
Worker Comp	$47	145%
Integrated Medical Solutions	$48	148%
Ca Dept Of Correction & Rehab	$50	154%
Employer Direct Healthcare	$50	154%
Naphcare	$56 - $72	173%
Scripps Health	$61	188%

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 $36.
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 Paradise Valley 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.