CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: AHMC Anaheim Regional Medical Center
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $60
- Cash Discount Price: $149
- vs. Medicare Baseline: 1.85x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at AHMC Anaheim Regional Medical Center is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $149. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.85x the Medicare baseline. Located in 1111 W La Palma Avenue, Anaheim, CA.
Cash / Self-Pay
$149
Average discount available for prompt cash payment at this facility.
Insurance Median
$60
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: $149 (460%)
Insurance Median: $60 (185%)
Cash: $149 (460% of Medicare)
Ins. Median: $60 (185% 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Ahmc Reciprocity Agreement | $5 - $82 | 15% |
| Aids Health Foundation | $5 - $35 | 15% |
| Allied Physicians | $5 - $54 | 15% |
| Altamed Health Network | $5 - $35 | 15% |
| Applecare Medical Group | $5 | 15% |
| Avanti | $5 - $43 | 15% |
| Beverly Hospital | $5 - $40 | 15% |
| Brand New Day | $5 - $45 | 15% |
| Emanate Health | $5 - $45 | 15% |
| Health Net | $5 | 15% |
| Health Net Inc | $5 - $209 | 15% |
| Healthcare Partners | $5 - $35 | 15% |
| Healthnet Cal Optima Medi-Cal/Healthy Families | $5 | 15% |
| Healthy Way La | $5 | 15% |
| Heritage Provider Network | $5 - $49 | 15% |
| Hollywood Presbyterian Advanced Med Mgmt Mcal | $5 | 15% |
| Hollywood Presbyterian Medpoint Mcal | $5 | 15% |
| Kaiser Foundation Hospitals | $5 - $35 | 15% |
| Medi-Cal | $5 | 15% |
| Medical Safety Net Program | $5 | 15% |
| Non Contracted Medi-Cal | $5 | 15% |
| Talbert Medical Group | $5 - $55 | 15% |
| Caloptima | $7 - $35 | 22% |
| Monarch Health Plan | $7 - $185 | 22% |
| Prospect Health Plan | $7 - $49 | 22% |
| Veterans Administration | $25 | 77% |
| Angels Baseball Workers Comp | $28 | 86% |
| Interplan | $30 - $190 | 93% |
| First Health | $32 - $231 | 99% |
| Orange County Preferred Provider Organization | $32 - $204 | 99% |
| Prospect Medical Group | $32 | 99% |
| Athens Administrators | $33 | 102% |
| Capp Care | $33 - $204 | 102% |
| Cigna | $33 - $530 | 102% |
| Corvel | $33 - $204 | 102% |
| Marriot Intl | $33 | 102% |
| Non Contracted Workers Comp | $33 | 102% |
| Alta Los Angeles Hospital | $34 | 105% |
| Netcare Life And Health Insurance | $34 - $68 | 105% |
| Tricare | $34 | 105% |
| Aetna | $35 - $107 | 108% |
| Alignment Health Plan | $35 | 108% |
| Apa Aco Inc | $35 | 108% |
| Blue Cross Blue Shield | $35 - $242 | 108% |
| Blue Shield Of California | $35 - $355 | 108% |
| California Health Plan | $35 | 108% |
| Central Health Of California | $35 | 108% |
| Davita Heatlhcare Partners Plan Inc | $35 - $147 | 108% |
| Healthnet | $35 | 108% |
| Humana | $35 | 108% |
| Medicare (plans) | $35 - $136 | 108% |
| Pacificare | $35 | 108% |
| Scan Health Plan | $35 | 108% |
| Seoul Medical Group | $35 - $36 | 108% |
| Wellcare | $35 | 108% |
| Cv-19 Hrsa Uninsured Testing And Tx I/P And O/P | $36 | 111% |
| Innovative Integrated Health (Iih)/Orange County Pace | $36 | 111% |
| Monarch Healthcare Medical Group | $36 | 111% |
| Private Pay Flat Rate | $36 | 111% |
| Self-Pay | $36 | 111% |
| Nchp | $37 | 114% |
| Align Senior Care | $38 | 117% |
| Advance Clinical Research Institute | $41 - $82 | 127% |
| Affiliated Doctors Of Orange County | $45 | 139% |
| Ahmc Health Self-Insurance Epo | $45 | 139% |
| Knox-Keene Act | $45 | 139% |
| Medical Acquisition Company | $55 - $109 | 170% |
| Healthcare Partners Commercial | $74 - $147 | 228% |
| Huntington Memorial Hospital | $74 - $147 | 228% |
| Msi/Medical Services For Indigents | $75 | 231% |
| Genesis Healthcare Ipa Ancillary | $82 - $163 | 253% |
| Affiliated Health Fund | $96 - $190 | 296% |
| Allnet Preferred Provider | $96 - $190 | 296% |
| Care First | $96 - $190 | 296% |
| Private Healthcare Systems | $96 - $190 | 296% |
| Memorial Healthcare Ipa | $100 | 309% |
| Choicecare | $103 - $204 | 318% |
| Multiplan Inc | $103 - $204 | 318% |
| National Provider Network | $110 - $218 | 340% |
| Three Rivers Providers Network | $110 - $218 | 340% |
| Health Payors Organization | $123 - $245 | 380% |
| Non Contracted Commercial | $137 - $272 | 423% |
| UnitedHealthcare | $198 - $344 | 611% |
| Memorial Healthcare Ipa/Cap/Valuation Rates | $1,403 | 4330% |