CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Chinese Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $43
Cash Discount Price: $315
vs. Medicare Baseline: 1.33x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Chinese Hospital is $43. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $315. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.33x the Medicare baseline. Located in 845 Jackson St, San Francisco, CA.

Cash / Self-Pay

$315

Average discount available for prompt cash payment at this facility.

Insurance Median

$43

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: $315 (972%)

Insurance Median: $43 (133%)

Cash: $315 (972% of Medicare)

Ins. Median: $43 (133% 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
Blue Cross Blue Shield	$8 - $129	25%
Medi-Cal	$8	25%
San Francisco Health Plan- All Plans	$8	25%
Hp Of San Mateo Medi-Cal	$9	28%
Blue Shield Medi-Cal	$10	31%
Hp Of San Mateo Health Kids/Health Worx-All Other	$10	31%
Asian Medical Group Medi-Cal Op Only	$11	34%
Jade Medi-Cal	$14	43%
Aetna	$41 - $180	127%
Cchp Mcr Adv	$41	127%
Jade Mcr Adv	$41	127%
Jade-All Other Plans	$45	139%
On Lok Mcr Adv-All Plans	$45	139%
Blue Shield - All Other Plans	$96	296%
Health Net-All Plans	$167	515%
Cigna	$173	534%
Cchp-All Other Plans	$268	827%
Hp Of San Mateo Mcr Adv	$284	877%
Asian Medical Group Mcare Op Only-All Other Plans	$315	972%
Bay Area Accountable Care Mcare	$315	972%
Bay Area Accountable Care - All Other Plans	$567	1750%

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 $315.
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 Chinese 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.