CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Menifee Global Medical Center
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $37
- Cash Discount Price: $167
- vs. Medicare Baseline: 1.06x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Menifee Global Medical Center is $37. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $167. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.06x the Medicare baseline. Located in 28400 McCall Boulevard, Sun City, CA.
Cash / Self-Pay
$167
Average discount available for prompt cash payment at this facility.
Insurance Median
$37
Median negotiated contract rate across all mapped commercial carriers.
Medicare Reference Rate
$35.07
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. Medicare
Medicare Reference Baseline: $35.07 (100%)
Cash / Self-Pay: $167 (476%)
Insurance Median: $37 (106%)
Cash: $167 (476% of Medicare)
Ins. Median: $37 (106% of Medicare)
Understanding this gauge: We use the federal Medicare rate of $35.07 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
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Lasalle Medical Assoc (Ancillary) Mcal Hmo | $13 | 37% |
| Health Net Medi-Cal | $16 | 46% |
| Ic | $16 - $167 | 46% |
| Kaiser Medi-Cal | $16 | 46% |
| Prospect Health Plan Mcal Hmo | $16 | 46% |
| Blue Cross Blue Shield | $17 | 48% |
| Molina Medi-Cal | $19 | 54% |
| Altamed Mcal Hmo | $22 | 63% |
| Altamed Mcal/Pace | $22 | 63% |
| Hpn Mcal | $22 | 63% |
| Iehp Medi-Cal | $24 | 68% |
| Coventry | $30 - $31 | 86% |
| Prime Health Services Wcomp | $30 | 86% |
| Tricare | $32 - $35 | 91% |
| Three Rivers Wcomp | $33 | 94% |
| Workers Comp Non-Contracted | $33 | 94% |
| Aetna | $37 - $213 | 106% |
| Altamed Comm Hmo (Ancillary) | $37 - $167 | 106% |
| Altamed Health Services Senior | $37 | 106% |
| Altamed Sr/Pace | $37 | 106% |
| Blue Shield Senior | $37 | 106% |
| Central Health Plan Senior | $37 | 106% |
| Clever Care Health Plan Sr | $37 | 106% |
| For Your Benefit Senior | $37 | 106% |
| Guidant Health Plan Senior | $37 | 106% |
| Health Net Senior | $37 | 106% |
| Hpn Senior | $37 | 106% |
| Humana | $37 | 106% |
| Imperial Health Plan Of Ca | $37 | 106% |
| Kaiser Senior | $37 | 106% |
| Lasalle Medical Assoc (Ancillary) Commercial | $37 | 106% |
| Lasalle Medical Assoc (Ancillary) Senior | $37 | 106% |
| Managed Health Network Sr | $37 | 106% |
| Medicare (plans) | $37 | 106% |
| Neighborhood Healthcare Pace | $37 | 106% |
| Point Comfort Underwriters | $37 | 106% |
| Primecare Senior | $37 | 106% |
| Prospect Health Plan Sr Hmo | $37 | 106% |
| Scan Senior | $37 | 106% |
| Self Pay/Ab774/Charity Discount | $37 | 106% |
| Sr Capitation | $37 | 106% |
| UnitedHealthcare | $37 - $117 | 106% |
| Veterans Administration | $37 | 106% |
| Align Senior Care | $42 | 120% |
| Welbehealth Sr/Pace | $42 | 120% |
| Prime Health Services Senior | $43 | 123% |
| Iehp Covered Ca | $47 | 134% |
| Prospect Health Plan Comm Hmo | $50 | 143% |
| Health Net Enhanced Ppo | $52 | 148% |
| Hpn Commercial/Covered Ca | $52 | 148% |
| Molina Covered Ca | $52 | 148% |
| Health Net Comm | $56 | 160% |
| Three Rivers Network | $65 | 185% |
| Velocity | $65 - $75 | 185% |
| First Health Commercial | $88 | 251% |
| Blue Shield Epn | $105 | 299% |
| Primecare Commercial | $109 | 311% |
| Multiplan Ppo | $117 | 334% |
| Multiplan Wcomp | $117 | 334% |
| Blue Shield Commercial | $123 | 351% |
| Cigna | $134 - $315 | 382% |
| Pnoa-Provider Network Of America | $134 | 382% |
| Prime Health Services Commercial | $134 | 382% |
| Ava Hospice | $167 | 476% |
| Kaiser Commercial | $167 | 476% |
| Living Waters Hospice | $167 | 476% |
| Managed Health Network | $167 | 476% |
| Other Insurance Loa | $167 | 476% |
| Pacific Valley Hospice | $167 | 476% |
| Private Pay | $167 | 476% |
| Silverado Hospice | $167 | 476% |
| Vna Hospice | $167 | 476% |
| Choice Physicians Network | $175 | 499% |