CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Garfield Medical Center
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $147
- Cash Discount Price: $300
- vs. Medicare Baseline: 4.54x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Garfield Medical Center is $147. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $300. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 4.54x the Medicare baseline. Located in 525 N Garfield Ave, Monterey Park, CA.
Cash / Self-Pay
$300
Average discount available for prompt cash payment at this facility.
Insurance Median
$147
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: $300 (926%)
Insurance Median: $147 (454%)
Cash: $300 (926% of Medicare)
Ins. Median: $147 (454% 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 454% of the Medicare baseline (a markup of 354%). 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 Healthcare Inc | $5 - $123 | 15% |
| Aids Health Foundation | $5 - $35 | 15% |
| Allied Physicians | $5 - $54 | 15% |
| Avanti | $5 - $43 | 15% |
| Beverly Hospital | $5 - $40 | 15% |
| Blue Cross Blue Shield | $5 - $325 | 15% |
| Brand New Day | $5 - $45 | 15% |
| Care 1St Mcl/Gar Cap Reciprocity | $5 | 15% |
| Community Health Plan | $5 | 15% |
| Emanate Health | $5 - $45 | 15% |
| Health Net | $5 - $222 | 15% |
| Healthy Way La | $5 | 15% |
| Hollywood Presbyterian Advanced Med Mgmt Mcal | $5 | 15% |
| Hollywood Presbyterian Medpoint Mcal | $5 | 15% |
| La Care Health Plan | $5 - $225 | 15% |
| Other Non-Contracting Medi-Cal | $5 | 15% |
| State Of California Medi-Cal | $5 | 15% |
| Physician Healthways Medical Corporation | $6 | 19% |
| Caloptima Direct | $8 | 25% |
| Associated Hispanic Phys Of So Cal | $22 - $82 | 68% |
| Care First Health Plan | $22 - $41 | 68% |
| UnitedHealthcare | $22 - $245 | 68% |
| Veterans Administration | $25 | 77% |
| Interplan | $32 - $307 | 99% |
| Preferred Health Network | $32 | 99% |
| Athens Administrators | $33 | 102% |
| Multiplan | $33 - $348 | 102% |
| Other Non-Contracted Workers Compensation | $33 | 102% |
| Aetna | $35 - $298 | 108% |
| Apa Aco Inc | $35 | 108% |
| Blue Shield | $35 - $438 | 108% |
| Central Health Plan | $35 - $164 | 108% |
| Cms | $35 | 108% |
| Easy Choice Health Plan | $35 | 108% |
| Humana | $35 | 108% |
| Non-Contract Medi-Care | $35 | 108% |
| Pacific Alliance Medical Center Comm/Sr | $35 | 108% |
| Blue Shield Of California | $36 - $393 | 111% |
| Cv-19 Hrsa Uninsured Testing And Tx | $36 | 111% |
| First Health Network | $36 - $286 | 111% |
| La Care Covered Direct | $36 | 111% |
| Scan Health Plan Sr Hmo | $36 | 111% |
| Self-Pay | $36 | 111% |
| Ucla Impact Dept Of Uncology | $36 | 111% |
| Alignment Health Plan | $37 | 114% |
| Molina Healthcare | $37 | 114% |
| Molina Healthcare Of California | $37 - $45 | 114% |
| Inter Valley Health Plan | $38 | 117% |
| National Disaster Medical System | $40 | 123% |
| San Miguel Health Plan | $40 | 123% |
| Chinatown Service Center Pace | $43 | 133% |
| Employee Health Systems Mg | $43 - $82 | 133% |
| Advantage Care Ipa | $45 - $409 | 139% |
| Ahmc Health Epo | $45 | 139% |
| Knox-Keene Act | $45 | 139% |
| Physicians Healthways Medi-Cal | $45 - $409 | 139% |
| Physicians Healthways Medical Corporation | $45 - $409 | 139% |
| Health Net Comm/Hmo | $57 - $225 | 176% |
| Health Net Inc | $58 | 179% |
| Access Ipa Ancillary | $60 | 185% |
| Family Health Alliance | $60 | 185% |
| Pacific Independent Physician Association | $60 | 185% |
| Private Pay | $60 | 185% |
| Allied Physicians Risk Pool | $76 - $143 | 235% |
| Allied Physicians Risk Pool Agreement | $76 - $143 | 235% |
| Healthnet Medi Cal Cap | $76 - $143 | 235% |
| Pipa Risk Pool Agreement | $76 - $143 | 235% |
| Molina Medical Group | $85 - $160 | 262% |
| Health Net Foundation Comm/Sr (Family Health Alliance) | $87 - $164 | 269% |
| Health Net Foundation M Cal (Family Health Alliance) | $87 - $164 | 269% |
| Phys Assoc Of San Gab Valley | $87 - $164 | 269% |
| Allied Physicians Med Grp | $108 - $204 | 333% |
| Alhambra Hospital | $130 - $245 | 401% |
| Care 1St Health Plan | $130 - $245 | 401% |
| One Health Plan | $152 - $286 | 469% |
| Fmc Los Angeles Co Epo | $163 - $307 | 503% |
| Corvel Corporation | $174 - $327 | 537% |
| Pacificare Ppo | $181 | 559% |
| Americas Health Plan | $184 - $348 | 568% |
| Health Payors Organization | $195 - $368 | 602% |
| Cigna | $217 - $409 | 670% |
| East La Reg Ctr | $217 - $409 | 670% |
| Non Contract Commercial | $217 - $409 | 670% |
| One Legacy | $217 - $409 | 670% |
| Pacificare Of California Inc | $246 | 759% |