CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Community Memorial Hospital - Ventura

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $36
Cash Discount Price: $175
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Community Memorial Hospital - Ventura is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $175. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.11x the Medicare baseline. Located in 147 North Brent Street, Ventura, CA.

Cash / Self-Pay

$175

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $175 (540%)

Insurance Median: $36 (111%)

Cash: $175 (540% of Medicare)

Ins. Median: $36 (111% 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
Medi-Cal	$5	15%
Non Contracted	$5 - $35	15%
Gold Coast Health Plan	$8 - $102	25%
Medicaid / KanCare	$8 - $102	25%
Aetna	$28 - $202	86%
Blue Cross Blue Shield	$35 - $48	108%
California Workers Compensation	$35	108%
Medicare (plans)	$35 - $36	108%
Seaview	$35	108%
Tricare	$35	108%
Wellcare Of California	$35	108%
Alignment Health Plan	$36	111%
Humana	$36	111%
Scan Health Plan	$36	111%
UnitedHealthcare	$36 - $420	111%
Valley Care	$46 - $73	142%
Ventura County Health Care Plan	$73	225%
Multiplan	$175	540%
Cigna	$290	895%
Health Net Commercial	$292	901%
Kaiser Commercial	$528	1630%
Blue Shield Epn	$578	1784%
Blue Shield Commercial	$626	1932%

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 $175.
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 Community Memorial Hospital - Ventura 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.