Occupational therapy (self-care training)
Facility: Redlands Community Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $115
- Cash Discount Price: $87
- vs. Medicare Baseline: 3.55x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 355% of the Medicare baseline (a markup of 255%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Kaiser Medi-Cal | $29 | 90% |
| Epic Health Plan Senior | $34 - $204 | 105% |
| Health Net Healthy Families | $34 | 105% |
| Health Net Healthy Kids | $34 | 105% |
| Iehp Health Access Senior | $34 | 105% |
| Iehp Mcr Adv | $34 | 105% |
| Kaiser Senior | $34 | 105% |
| Tricare | $34 | 105% |
| UnitedHealthcare | $34 - $72 | 105% |
| Alinment Health Plan Mcr Adv-All Plans | $35 | 108% |
| Medicare (plans) | $35 | 108% |
| Health Net Mcr Adv | $37 | 114% |
| Universal Care-All Plans | $37 | 114% |
| Llumc Sr | $38 | 117% |
| Caremore Mcr Adv-All Plans | $41 | 127% |
| Central Health Plan Sr-All Plans | $41 | 127% |
| Dsh - All Plans | $45 | 139% |
| Epic Health Plan-All Other Plans | $45 - $204 | 139% |
| Patton Dsh Mcr Adv-All Plans | $45 | 139% |
| Llumc-All Other Plans | $48 | 148% |
| Blue Cross Blue Shield | $49 | 151% |
| Pacificare Bmg/Rymg Groups Only | $84 | 259% |
| Blue Shield Mcare | $97 | 299% |
| Pacificare (Rmg) - All Other Plans | $108 | 333% |
| Pinnacle Op Only-All Plans | $115 - $125 | 355% |
| Rymg Op Only-All Plans | $115 - $125 | 355% |
| Beaver-All Other Plans | $123 - $133 | 380% |
| Heritage/Regal Med Grp Sr | $180 | 556% |
| Heritage/Regal Med Grp-All Other Plans | $180 | 556% |
| Mhn-All Plans | $180 | 556% |
| Health Net-All Other Plans | $193 | 596% |
| Kaiser Comm-All Other Plans | $197 | 608% |
| Aetna | $235 | 725% |
| Coventry-All Plans | $253 | 781% |
| Multiplan Kaiser | $260 | 802% |
| Blue Shield Ppo/Epo/Hmo - All Other Plans | $269 - $294 | 830% |
| Choicecare-All Plans | $289 | 892% |
| Interplan - All Plans | $289 | 892% |
| Aps-All Plans | $307 | 948% |
| Beech Street-All Plans | $325 | 1003% |
| Medi-Cal | $361 | 1114% |
| Iehp Healthy Family And Kids | $397 | 1225% |
| Holman-All Plans | $403 | 1244% |
| Cigna | $420 | 1296% |
| Iehp - All Other Plans | $422 | 1302% |
| Molina Medi-Cal | $612 | 1889% |