Occupational therapy (self-care training)
Facility: Menifee Global Medical Center
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $75
- Cash Discount Price: $192
- vs. Medicare Baseline: 2.31x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 231% of the Medicare baseline (a markup of 131%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Health Net Medi-Cal | $5 | 15% |
| Ic | $5 - $217 | 15% |
| Kaiser Medi-Cal | $5 | 15% |
| Prospect Health Plan Mcal Hmo | $5 | 15% |
| Blue Cross Blue Shield | $6 | 19% |
| Lasalle Medical Assoc (Ancillary) Mcal Hmo | $6 | 19% |
| Molina Medi-Cal | $6 | 19% |
| Altamed Mcal Hmo | $7 | 22% |
| Altamed Mcal/Pace | $7 | 22% |
| Hpn Mcal | $7 | 22% |
| Iehp Medi-Cal | $8 | 25% |
| Tricare | $29 - $32 | 90% |
| Coventry | $30 - $31 | 93% |
| Prime Health Services Wcomp | $30 | 93% |
| Three Rivers Wcomp | $33 | 102% |
| Workers Comp Non-Contracted | $33 | 102% |
| Aetna | $34 - $213 | 105% |
| Altamed Comm Hmo (Ancillary) | $34 - $217 | 105% |
| Altamed Health Services Senior | $34 | 105% |
| Altamed Sr/Pace | $34 | 105% |
| Blue Shield Senior | $34 | 105% |
| Central Health Plan Senior | $34 | 105% |
| Clever Care Health Plan Sr | $34 | 105% |
| For Your Benefit Senior | $34 | 105% |
| Guidant Health Plan Senior | $34 | 105% |
| Health Net Senior | $34 | 105% |
| Hpn Senior | $34 | 105% |
| Humana | $34 | 105% |
| Imperial Health Plan Of Ca | $34 | 105% |
| Kaiser Senior | $34 | 105% |
| Lasalle Medical Assoc (Ancillary) Commercial | $34 | 105% |
| Lasalle Medical Assoc (Ancillary) Senior | $34 | 105% |
| Managed Health Network Sr | $34 | 105% |
| Medicare (plans) | $34 | 105% |
| Neighborhood Healthcare Pace | $34 | 105% |
| Point Comfort Underwriters | $34 | 105% |
| Primecare Senior | $34 | 105% |
| Prospect Health Plan Sr Hmo | $34 | 105% |
| Scan Senior | $34 | 105% |
| Self Pay/Ab774/Charity Discount | $34 | 105% |
| Sr Capitation | $34 | 105% |
| UnitedHealthcare | $34 - $117 | 105% |
| Veterans Administration | $34 | 105% |
| Align Senior Care | $38 | 117% |
| Welbehealth Sr/Pace | $38 | 117% |
| Prime Health Services Senior | $39 | 120% |
| Iehp Covered Ca | $43 | 133% |
| Molina Covered Ca | $44 | 136% |
| Prospect Health Plan Comm Hmo | $46 | 142% |
| Health Net Enhanced Ppo | $48 | 148% |
| Hpn Commercial/Covered Ca | $48 | 148% |
| Health Net Comm | $51 | 157% |
| Three Rivers Network | $60 | 185% |
| Velocity | $60 - $98 | 185% |
| First Health Commercial | $88 - $114 | 272% |
| Blue Shield Epn | $96 | 296% |
| Primecare Commercial | $109 - $141 | 336% |
| Blue Shield Commercial | $113 | 349% |
| Multiplan Ppo | $117 - $152 | 361% |
| Multiplan Wcomp | $117 - $152 | 361% |
| Cigna | $134 - $315 | 414% |
| Pnoa-Provider Network Of America | $134 - $174 | 414% |
| Prime Health Services Commercial | $134 - $174 | 414% |
| Ava Hospice | $167 - $217 | 515% |
| Kaiser Commercial | $167 - $217 | 515% |
| Living Waters Hospice | $167 - $217 | 515% |
| Managed Health Network | $167 - $217 | 515% |
| Other Insurance Loa | $167 - $217 | 515% |
| Pacific Valley Hospice | $167 - $217 | 515% |
| Private Pay | $167 - $217 | 515% |
| Silverado Hospice | $167 - $217 | 515% |
| Vna Hospice | $167 - $217 | 515% |
| Choice Physicians Network | $175 | 540% |