CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: John Muir Medical Center - Walnut Creek Campus

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $94
Cash Discount Price: $86
vs. Medicare Baseline: 2.90x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at John Muir Medical Center - Walnut Creek Campus is $94. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $86. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.90x the Medicare baseline. Located in 1601 Ygnacio Valley Rd, Walnut Creek, CA.

Cash / Self-Pay

$86

Average discount available for prompt cash payment at this facility.

Insurance Median

$94

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: $86 (265%)

Insurance Median: $94 (290%)

Cash: $86 (265% of Medicare)

Ins. Median: $94 (290% 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 290% of the Medicare baseline (a markup of 190%). 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
Jmpn Canopy Hn [1640000011]	$8 - $38	25%
UnitedHealthcare	$8 - $116	25%
Golden State-Network Mcare [1023127]	$37	114%
Tricare	$37 - $42	114%
Alignment Health [1177113]	$40 - $41	123%
Blue Cross Blue Shield	$40 - $589	123%
Care 1St Health Plan [1094113]	$40 - $41	123%
Caremore [1171113]	$40 - $41	123%
Essence Healthcare [1049028]	$40 - $41	123%
Essence Healthcare [1049128]	$40 - $41	123%
Generic Commercial/Indemnity [1017001]	$40 - $80	123%
Generic Hmo [1018103]	$40	123%
Generic Ppo [1021104]	$40	123%
Health Net-Network Mcare [1028127]	$40	123%
Humana	$40 - $165	123%
Medicare (plans)	$40 - $159	123%
Veterans Administration [1051113]	$40 - $41	123%
Aetna	$41 - $147	127%
Blue Shield-Network Mcare [1006127]	$41 - $42	127%
Covid19 Hrsa Uninsured Testing And Treatment Fund [1179012]	$41 - $42	127%
Easy Choice Health Plan [1083113]	$41 - $42	127%
Scan-Network Mcare [1043127]	$41 - $42	127%
Hospice Of East Bay [1085104]	$42	130%
Workers' Comp [1024005]	$50	154%
Canopy Hn Hmo [1166103]	$74 - $75	228%
Carecentrix [1011001]	$74 - $80	228%
Aps Healthcare [1003103]	$83 - $89	256%
United Behavioral Health [1048103]	$93 - $100	287%
Cigna	$94 - $142	290%
Carelon Behavioral Health [1050104]	$102 - $109	315%
Fortified Provider Network [1063104]	$102 - $109	315%
Medigap [1036001]	$102 - $109	315%
Three Rivers Provider Network [1073104]	$102 - $109	315%
Health Net Hmo [1028103]	$105 - $113	324%
Health Net-Network [1028026]	$105 - $113	324%
Contra Costa Health Plan Hmo [1013103]	$111 - $119	343%
Blue Shield Hmo [1006103]	$115 - $126	355%
Blue Shield-Network [1006026]	$115 - $126	355%
Blue Shield Ppo [1006104]	$123 - $146	380%
Western Health Advantage Hmo [1053103]	$129 - $159	398%
Health Net Ppo [1028104]	$134 - $144	414%
Federal Correction Institute [1062104]	$148 - $159	457%
First Health [1016104]	$148 - $169	457%
Healthsmart - Pka Interplan [1031104]	$148 - $159	457%
National Provider Network/Plancare America [1069104]	$148 - $159	457%
Networks By Design [1084104]	$148 - $159	457%
Pponext [1072104]	$148 - $159	457%
Sutter Preferred Health Plan [1044104]	$148 - $159	457%
Kaiser Hmo [1033103]	$150 - $161	463%
Health Management Network [1066104]	$157 - $169	485%
Healthcomp [1089104]	$157 - $589	485%
Galaxy Health Network [1064104]	$166 - $179	512%
Integrated Health Plan [1075104]	$166 - $179	512%
Brms [1091104]	$504 - $589	1556%
Delta Health Systems [1032104]	$504 - $589	1556%
Empire Plan [1092104]	$504 - $589	1556%
Donor Network West [1008103]	$8,000 - $12,000	24691%

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 $86.
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 John Muir Medical Center - Walnut Creek Campus 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.