CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Southwest Healthcare Rancho Springs Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $89
Cash Discount Price: $98
vs. Medicare Baseline: 2.75x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Southwest Healthcare Rancho Springs Hospital is $89. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $98. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.75x the Medicare baseline. Located in 25500 Medical Center Drive, Murrieta, CA.

Cash / Self-Pay

$98

Average discount available for prompt cash payment at this facility.

Insurance Median

$89

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: $98 (302%)

Insurance Median: $89 (275%)

Cash: $98 (302% of Medicare)

Ins. Median: $89 (275% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 275% of the Medicare baseline (a markup of 175%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
Health_Net	$6 - $86	19%
Heritage	$8 - $96	25%
United_Healthcare	$8	25%
Iehp	$10	31%
Aetna	$68 - $75	210%
Kaiser	$68 - $75	210%
Cigna	$82 - $90	253%
Primecare	$91 - $100	281%
Palomar	$108 - $118	333%
Rady_Children'S_Hospital	$160 - $176	494%
Blue Cross Blue Shield	$190	586%
Multiplan	$206 - $227	636%
Sharp_Health_Plan	$206 - $227	636%

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 $98.
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 Southwest Healthcare Rancho Springs 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.