CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Whittier Hospital Medical Center
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $75
- Cash Discount Price: $26
- vs. Medicare Baseline: 2.31x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Whittier Hospital Medical Center is $75. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $26. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 2.31x the Medicare baseline. Located in 9080 Colima Rd, Whittier, CA.
Cash / Self-Pay
$26
Average discount available for prompt cash payment at this facility.
Insurance Median
$75
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: $26 (80%)
Insurance Median: $75 (231%)
Cash: $26 (80% of Medicare)
Ins. Median: $75 (231% 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 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.
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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 |
|---|---|---|
| Ahmc Medi-Cal Reciprocity Agreement | $5 | 15% |
| Aids Healthcare Foundation | $5 - $35 | 15% |
| Allied Physicians | $5 - $54 | 15% |
| Alta Med Health Network | $5 - $35 | 15% |
| Altamed Health Services Corporation | $5 | 15% |
| Avanti | $5 - $43 | 15% |
| Beverly Hospital | $5 - $40 | 15% |
| Brand New Day | $5 - $44 | 15% |
| Care First Health Plan | $5 | 15% |
| County Of Los Angeles Dept Of Health Services | $5 | 15% |
| Emanate Health | $5 - $44 | 15% |
| Health Net | $5 - $170 | 15% |
| Healthy Way La | $5 | 15% |
| Heritage Provider Network | $5 - $49 | 15% |
| Hollywood Presbyterian Adv Med Mcal | $5 | 15% |
| Hollywood Presbyterian Medpoint Mcal | $5 | 15% |
| Kaiser Foundation | $5 - $200 | 15% |
| La Care Healthy Families/Healthy Kids | $5 | 15% |
| Medi Caid/ Medi Cal | $5 | 15% |
| Non Contracted Medi-Cal | $5 | 15% |
| Prospect Health Plan | $5 - $58 | 15% |
| Synermed | $5 - $36 | 15% |
| Blue Cross Blue Shield | $6 - $293 | 19% |
| La Care Health Plan | $6 - $157 | 19% |
| Caloptima | $7 - $35 | 22% |
| Monarch Healthplan | $7 | 22% |
| Physicians Healthways Medical Corporation | $11 | 34% |
| Physician Healthways | $15 - $28 | 46% |
| Veterans Administration | $25 | 77% |
| Applecare Medical Group | $30 | 93% |
| Fmc Los Angeles County | $32 - $214 | 99% |
| Interplan Health Group | $32 | 99% |
| Aetna | $33 - $207 | 102% |
| Athens Administrators Ahmc Work Comp | $33 | 102% |
| Misc 1 | $33 | 102% |
| Multiplan Wc | $33 | 102% |
| Alignment Health Plan | $35 | 108% |
| Alta Los Angeles Hospitals Inc | $35 | 108% |
| Apa/Aco Inc | $35 | 108% |
| Central Health Plan | $35 | 108% |
| Easy Choice Health Plan | $35 | 108% |
| Humana | $35 | 108% |
| Medicare (plans) | $35 - $37 | 108% |
| Pacificare Of California | $35 | 108% |
| Scan Health Plan | $35 | 108% |
| Blue Shield Of California | $36 - $433 | 111% |
| Caremore | $36 | 111% |
| Cov19 Hrsa Uninsured Testing And Treatment Fund | $36 | 111% |
| La Care Covered Direct | $36 | 111% |
| Pacific Alliance Medical Center | $36 | 111% |
| Private Pay | $36 | 111% |
| Self-Pay | $36 | 111% |
| Tricare | $36 | 111% |
| Molina Healthcare Of California | $37 | 114% |
| San Miguel Health Plan | $40 | 123% |
| Chinatown Service Center Pace | $43 | 133% |
| Ahmc Health | $45 | 139% |
| Ahmc Reciprocity | $45 - $86 | 139% |
| Ahmc Reciprocity Agreement Senior/Commercial | $45 - $86 | 139% |
| Knox-Keene Act | $45 | 139% |
| Molina Medical Center | $45 - $111 | 139% |
| Wear And Wood | $45 - $114 | 139% |
| Capnet | $60 | 185% |
| Central Health Plan Of California | $60 - $114 | 185% |
| Pacific Independent Physician Association | $60 | 185% |
| Edward Medical Group | $65 | 201% |
| Allied Physicians Ipa | $69 | 213% |
| UnitedHealthcare | $72 - $267 | 222% |
| Prospect Medical | $82 - $157 | 253% |
| Health Net Inc | $88 - $135 | 272% |
| Care 1St Health Plan | $90 - $171 | 278% |
| New Horizon Medical Group Inc | $90 - $171 | 278% |
| Davita Healthcare Partners | $94 | 290% |
| Cost Containment | $98 - $185 | 302% |
| Universal Care | $98 - $200 | 302% |
| Asi/Flex | $105 - $200 | 324% |
| Us Comp Care | $105 - $200 | 324% |
| Value Healthplan Of California | $105 - $200 | 324% |
| Healthnet | $108 - $234 | 333% |
| Community Care Network | $112 - $214 | 346% |
| Coventry Health Care | $112 - $214 | 346% |
| Coventry Health Care National Network | $112 - $214 | 346% |
| Interplan Corporation | $112 - $214 | 346% |
| Managed Care Administrators | $112 - $214 | 346% |
| Prohealth | $112 - $214 | 346% |
| Multiplan | $128 - $242 | 395% |
| Cigna | $150 - $285 | 463% |
| Commercial Non Contract | $150 - $285 | 463% |
| Medi-Cal Sub Acute | $150 - $285 | 463% |
| One Legacy | $150 - $285 | 463% |
| Great-West Healthcare Of California | $2,500 | 7716% |