CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Grossmont Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $108
Cash Discount Price: $134
vs. Medicare Baseline: 3.33x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Grossmont Hospital is $108. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $134. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.33x the Medicare baseline. Located in 5555 Grossmont Center Drive Box 58, La Mesa, CA.

Cash / Self-Pay

$134

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: $134 (414%)

Insurance Median: $108 (333%)

Cash: $134 (414% 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
Blue Cross Blue Shield	$11 - $124	34%
UnitedHealthcare	$11 - $626	34%
County Medical Services	$27 - $101	83%
Blue Shield	$31 - $143	96%
Aetna	$53 - $138	164%
Humana	$53 - $114	164%
Managed Health Network	$53	164%
Health Net	$54 - $134	167%
Community Health Group	$61 - $125	188%
Kaiser	$61 - $134	188%
Molina	$61 - $100	188%
Epic Americas	$86 - $626	265%
San Diego Pace	$90 - $147	278%
California Health And Wellness	$107	330%
Medi-Cal	$109	336%
Medicare (plans)	$109 - $134	336%
Interplan	$117 - $125	361%
Cigna	$121	373%
Indian Health Council	$125 - $161	386%
Multiplan	$125	386%
Allianz Global Assistance	$161 - $626	497%

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 $134.
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 Grossmont 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.