CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Marinhealth Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $213
Cash Discount Price: $447
vs. Medicare Baseline: 6.57x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Marinhealth Medical Center is $213. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $447. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 6.57x the Medicare baseline. Located in 250 Bon Air Road, Greenbrae, CA.

Cash / Self-Pay

$447

Average discount available for prompt cash payment at this facility.

Insurance Median

$213

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: $447 (1380%)

Insurance Median: $213 (657%)

Cash: $447 (1380% of Medicare)

Ins. Median: $213 (657% 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 657% of the Medicare baseline (a markup of 557%). 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
Aetna	$41 - $86	127%
Brown And Tolan	$41	127%
Healthnet Tailored Network	$41	127%
Kaiser	$41	127%
Marin Cancer Care	$41	127%
Ca Prison Health Care Services	$65	201%
Healthnet Enhancedcare	$106	327%
Blue Cross Blue Shield	$126 - $160	389%
Provider Network Of America	$193	596%
Canopy	$234	722%
Canopy Hill Physicians	$234	722%
Blue Shield Cpic/Epo	$241	744%
Providers Network Of America	$256	790%
Blue Shield Hmo/Ppo	$268	827%
Hills Blue Shield Hmo/Ppo	$268	827%
Healthnet Hmo/Ppo	$271	836%
Healthnet Hmo/Ppo Hill Physicians	$271	836%
Blue Shield Aco	$277	855%
Cigna	$662	2043%
UnitedHealthcare	$2,330	7191%

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 $447.
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 Marinhealth Medical Center 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.