CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Highland Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $41
Cash Discount Price: $152
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Highland Hospital is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $152. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.27x the Medicare baseline. Located in 1411 East 31St Street, Oakland, CA.

Cash / Self-Pay

$152

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $152 (469%)

Insurance Median: $41 (127%)

Cash: $152 (469% of Medicare)

Ins. Median: $41 (127% 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.

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
Kaiser Medi-Cal Managed Care [1026106]	$5	15%
Alameda Alliance Commercial Alternate [4801]	$7	22%
Alameda Alliance Mgd Mcal Alternate [2801]	$7	22%
Alameda Alliance Non-Verified [1002303]	$7	22%
Alameda Alliance [1002106]	$7	22%
Alameda Alliance [1002206]	$7	22%
Mc Alameda Alliance Capitation [1002103]	$7	22%
Aetna	$41 - $187	127%
Blue Cross Blue Shield	$41 - $333	127%
Brown Toland Medical Group Alternate [1049301]	$41	127%
Brown Toland Medical Group [1049001]	$41	127%
Brown Toland Mgd Mcr Alternate [1802]	$41	127%
Medicare (plans)	$41	127%
UnitedHealthcare	$110 - $146	340%
Health Net [1022001]	$142	438%
Kaiser Commercial [1026001]	$198	611%
Blue Shield [1006001]	$212 - $251	654%
Cigna	$229	707%

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 $152.
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 Highland 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.