Occupational therapy (self-care training)
Facility: Alhambra Hospital Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $76
- Cash Discount Price: $195
- vs. Medicare Baseline: 2.35x 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 235% of the Medicare baseline (a markup of 135%). 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 |
|---|---|---|
| Ahmc-Reciprocity-Medi-Cal/Healthy Families | $5 | 15% |
| Allied Physicians Of Ca Medi-Cal | $5 | 15% |
| Citrus Valley Health Partners | $5 | 15% |
| Health Net Medi-Cal | $5 | 15% |
| Kaiser Medi-Cal | $5 | 15% |
| La Care Pasc Seiu Misc | $5 | 15% |
| Medi-Cal | $5 | 15% |
| Miscellaneous Medi-Cal Hmo | $5 | 15% |
| Blue Cross Blue Shield | $6 - $47 | 19% |
| La Care Medi-Cal Hmo | $6 | 19% |
| Stewart Mg Senior Hmo | $25 | 77% |
| Aetna | $33 - $36 | 102% |
| Miscellaneous Work Comp Hmo | $33 | 102% |
| Blue Shield 65 Plus | $34 | 105% |
| Altamed Senior Services | $35 | 108% |
| Apa Aco | $35 | 108% |
| Brand New Day Sr | $35 | 108% |
| Central Health Plan Of Ca Senior Hmo | $35 | 108% |
| Health Net Senior Hmo | $35 | 108% |
| Medicare (plans) | $35 - $132 | 108% |
| Humana | $36 | 111% |
| La Care Exchange | $36 | 111% |
| Miscellaneous Senior Hmo | $36 | 111% |
| Tricare | $36 | 111% |
| UnitedHealthcare | $36 - $263 | 111% |
| Wellcare Senior Hmo | $36 | 111% |
| Alignment Senior Hmo | $37 | 114% |
| Health Net Exchange | $44 | 136% |
| Health Net Salud Con Hmo | $44 | 136% |
| Molina Exchange | $44 | 136% |
| Ahmc Health | $53 | 164% |
| Allied Physicians Of Ca Commercial | $54 | 167% |
| Ahmc-Reciprocity-Comm/Senior | $57 - $66 | 176% |
| Allied Physicians Comm/Sr | $66 - $77 | 204% |
| Allied Physicians Medi-Cal | $66 - $77 | 204% |
| Wellcare Allied Senior Hmo | $66 - $77 | 204% |
| Molina Health Plan | $74 - $86 | 228% |
| Health Net Ppo/Epo/Pos | $75 | 231% |
| Self Pay | $76 - $88 | 235% |
| Kaiser Commercial | $118 - $137 | 364% |
| Scan Senior Plan | $123 - $143 | 380% |
| Multiplan | $152 - $176 | 469% |
| Miscellaneous Commercial Ppo/Hmo | $190 - $220 | 586% |
| Health Net Exchange Enhanced Ppo | $229 | 707% |
| Cigna | $339 - $527 | 1046% |
| Blue Shield Value Network Exchange | $389 | 1201% |
| Blue Shield Hmo/Ppo | $433 | 1336% |