CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Scripps Memorial Hospital - Encinitas
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $36
- Cash Discount Price: $24
- vs. Medicare Baseline: 1.11x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Scripps Memorial Hospital - Encinitas is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $24. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.11x the Medicare baseline. Located in 354 Santa Fe Drive, Encinitas, CA.
Cash / Self-Pay
$24
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: $24 (74%)
Insurance Median: $36 (111%)
Cash: $24 (74% 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.
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 |
|---|---|---|
| Radys Cpmg [803] | $8 | 25% |
| Blue Cross Blue Shield | $20 - $59 | 62% |
| Bc [814] | $21 - $22 | 65% |
| Imperial County Phys Med Group [855] | $21 - $34 | 65% |
| Integrated Health Partners [894] | $21 - $22 | 65% |
| Perlman Med Group [899] | $21 - $22 | 65% |
| Sharp Comm Med Grp [812] | $21 - $45 | 65% |
| Sharp Rees Stealy Med Grp [811] | $21 - $45 | 65% |
| Ucsd [807] | $21 - $45 | 65% |
| Centivo [581] | $22 - $23 | 68% |
| Cigna | $30 - $59 | 93% |
| Blue Shield [230] | $31 - $36 | 96% |
| Bs [816] | $32 - $35 | 99% |
| Health Net [340] | $32 - $90 | 99% |
| Hn [815] | $32 - $33 | 99% |
| Uh [819] | $33 - $35 | 102% |
| UnitedHealthcare | $33 - $50 | 102% |
| Aetna | $36 - $50 | 111% |
| Astiva Mcr Adv [464] | $36 | 111% |
| Bc Mcr Adv [830] | $36 | 111% |
| Bs Mcr Adv [829] | $36 | 111% |
| Central Health Mcr Adv [441] | $36 | 111% |
| Clever Care Mcr Adv [465] | $36 | 111% |
| D-Snp Mcr Adv [889] | $36 | 111% |
| Dsnp/Csnp - Generic [458] | $36 | 111% |
| Family Health Centers Pace Mcr Adv Hmo [556] | $36 | 111% |
| Family Health Centers Pace Medi-Cal [555] | $36 | 111% |
| Gary And Mary West Pace Medi-Cal Hmo [557] | $36 | 111% |
| Gpmg/Altura - Mcr Adv [888] | $36 | 111% |
| Hn Mcr Adv [832] | $36 | 111% |
| Humana | $36 | 111% |
| Integrated Health Partners - Mcr Adv [895] | $36 | 111% |
| Kaiser Northern Ca Region Mcr Adv [386] | $36 | 111% |
| La Care Mcr Adv Hmo [612] | $36 | 111% |
| Medicare (plans) | $36 | 111% |
| Mpmg Mcr Adv [836] | $36 | 111% |
| Mpmg [800] | $36 | 111% |
| Ocn Mcr Adv [890] | $36 | 111% |
| San Diego Pace Medi-Cal [553] | $36 | 111% |
| Scan Mcr Adv [835] | $36 | 111% |
| Scan [500] | $36 | 111% |
| Scan [818] | $36 | 111% |
| Sharp Comm Med Grp Mcr Adv [840] | $36 | 111% |
| Sharp Health Plan Mcr Adv [531] | $36 | 111% |
| Sharp Health Plan Mcr Adv [897] | $36 | 111% |
| Sharp Rees Stealy Med Grp Mcr Adv [841] | $36 | 111% |
| St Paul'S Pace Medi-Cal [551] | $36 | 111% |
| Ucsd Mcr Adv [873] | $36 | 111% |
| Uh Mcr Adv [831] | $36 | 111% |
| Uh Palomar Health Mcr Adv [885] | $36 | 111% |
| Alignment Health Plan [443] | $37 | 114% |
| Rady Children'S Hospital [825] | $39 - $41 | 120% |
| Palomar Health [892] | $43 - $45 | 133% |
| Veba Med Grp [813] | $43 - $45 | 133% |
| Kaiser Northern Ca Region Hmo/Ppo [384] | $54 - $57 | 167% |
| Kaiser [380] | $54 - $57 | 167% |
| Kaiser [383] | $54 - $57 | 167% |
| Mc Alignment [917] | $59 | 182% |
| Mc Blue Shield Promise Health Plan [914] | $59 | 182% |
| Mc Blue Shield [902] | $59 | 182% |
| Mc Health Net [904] | $59 | 182% |
| Mc Scan [905] | $59 | 182% |
| Mc United [906] | $59 | 182% |
| Prime Healthcare [614] | $61 | 188% |
| Prospect Med Group [893] | $63 | 194% |
| Multi Plan Network [470] | $67 - $71 | 207% |
| First Health Network [330] | $71 - $75 | 219% |
| Pnoa [615] | $71 - $75 | 219% |
| Choice Care Network [270] | $76 - $80 | 235% |
| Healthsmart [350] | $76 - $80 | 235% |