CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Garfield Medical Center
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $208
- Cash Discount Price: $389
- vs. Medicare Baseline: 5.93x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Garfield Medical Center is $208. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $389. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 5.93x the Medicare baseline. Located in 525 N Garfield Ave, Monterey Park, CA.
Cash / Self-Pay
$389
Average discount available for prompt cash payment at this facility.
Insurance Median
$208
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: $389 (1109%)
Insurance Median: $208 (593%)
Cash: $389 (1109% of Medicare)
Ins. Median: $208 (593% 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.
Elevated Commercial Rate Alert (Value-Gap)
The negotiated rate at this facility is 593% of the Medicare baseline (a markup of 493%). 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 |
|---|---|---|
| Allied Physicians | $9 - $59 | 26% |
| Blue Cross Blue Shield | $9 - $490 | 26% |
| Ahmc Healthcare Inc | $11 - $294 | 31% |
| Beverly Hospital | $11 - $43 | 31% |
| Brand New Day | $11 - $49 | 31% |
| Care 1St Mcl/Gar Cap Reciprocity | $11 | 31% |
| Community Health Plan | $11 | 31% |
| Emanate Health | $11 - $49 | 31% |
| Health Net | $11 - $532 | 31% |
| Healthy Way La | $11 | 31% |
| La Care Health Plan | $11 - $539 | 31% |
| Other Non-Contracting Medi-Cal | $11 | 31% |
| Aids Health Foundation | $13 - $39 | 37% |
| Avanti | $13 - $47 | 37% |
| Hollywood Presbyterian Advanced Med Mgmt Mcal | $13 | 37% |
| Hollywood Presbyterian Medpoint Mcal | $13 | 37% |
| State Of California Medi-Cal | $13 | 37% |
| Associated Hispanic Phys Of So Cal | $15 - $196 | 43% |
| Care First Health Plan | $15 - $98 | 43% |
| Physician Healthways Medical Corporation | $15 | 43% |
| UnitedHealthcare | $15 - $588 | 43% |
| Caloptima Direct | $19 | 54% |
| Veterans Administration | $27 | 77% |
| Employee Health Systems Mg | $29 - $196 | 83% |
| Interplan | $32 - $735 | 91% |
| Preferred Health Network | $32 | 91% |
| Athens Administrators | $33 | 94% |
| Multiplan | $33 - $833 | 94% |
| Other Non-Contracted Workers Compensation | $33 | 94% |
| Aetna | $35 - $713 | 100% |
| Apa Aco Inc | $39 | 111% |
| Blue Shield | $39 - $438 | 111% |
| Blue Shield Of California | $39 - $490 | 111% |
| Central Health Plan | $39 - $392 | 111% |
| Cms | $39 | 111% |
| Cv-19 Hrsa Uninsured Testing And Tx | $39 | 111% |
| Easy Choice Health Plan | $39 | 111% |
| First Health Network | $39 - $686 | 111% |
| Humana | $39 | 111% |
| La Care Covered Direct | $39 | 111% |
| Non-Contract Medi-Care | $39 | 111% |
| Pacific Alliance Medical Center Comm/Sr | $39 | 111% |
| Scan Health Plan Sr Hmo | $39 | 111% |
| Self-Pay | $39 | 111% |
| Ucla Impact Dept Of Uncology | $39 | 111% |
| Alignment Health Plan | $41 | 117% |
| Inter Valley Health Plan | $41 | 117% |
| Molina Healthcare | $41 | 117% |
| Molina Healthcare Of California | $41 - $49 | 117% |
| National Disaster Medical System | $43 | 123% |
| San Miguel Health Plan | $43 | 123% |
| Advantage Care Ipa | $45 - $980 | 128% |
| Physicians Healthways Medi-Cal | $45 - $980 | 128% |
| Physicians Healthways Medical Corporation | $45 - $980 | 128% |
| Chinatown Service Center Pace | $47 | 134% |
| Ahmc Health Epo | $49 | 140% |
| Knox-Keene Act | $49 | 140% |
| Allied Physicians Risk Pool | $51 - $343 | 145% |
| Allied Physicians Risk Pool Agreement | $51 - $343 | 145% |
| Healthnet Medi Cal Cap | $51 - $343 | 145% |
| Pipa Risk Pool Agreement | $51 - $343 | 145% |
| Molina Medical Group | $57 - $382 | 163% |
| Health Net Foundation Comm/Sr (Family Health Alliance) | $58 - $392 | 165% |
| Health Net Foundation M Cal (Family Health Alliance) | $58 - $392 | 165% |
| Phys Assoc Of San Gab Valley | $58 - $392 | 165% |
| Access Ipa Ancillary | $60 | 171% |
| Family Health Alliance | $60 | 171% |
| Pacific Independent Physician Association | $60 | 171% |
| Private Pay | $60 | 171% |
| Health Net Comm/Hmo | $62 - $539 | 177% |
| Health Net Inc | $64 | 182% |
| Allied Physicians Med Grp | $73 - $490 | 208% |
| Alhambra Hospital | $88 - $588 | 251% |
| Care 1St Health Plan | $88 - $588 | 251% |
| One Health Plan | $102 - $686 | 291% |
| Fmc Los Angeles Co Epo | $110 - $735 | 314% |
| Corvel Corporation | $117 - $784 | 334% |
| Americas Health Plan | $124 - $833 | 354% |
| Health Payors Organization | $131 - $882 | 374% |
| Cigna | $146 - $453 | 416% |
| East La Reg Ctr | $146 - $980 | 416% |
| Non Contract Commercial | $146 - $980 | 416% |
| One Legacy | $146 - $980 | 416% |
| Pacificare Ppo | $181 | 516% |
| Pacificare Of California Inc | $246 | 701% |