Occupational therapy (therapeutic activities)
Facility: Greater El Monte Community Hospital
Billing Code: 97530 (CPT)
- CPT Billing Code: 97530
- Insurance Median: $100
- Cash Discount Price: $165
- vs. Medicare Baseline: 2.85x Medicare
Average discount available for prompt cash payment at this facility.
Median negotiated contract rate across all mapped commercial carriers.
Standard federal government reimbursement rate for this code.
Visual Cost Comparison vs. 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 285% of the Medicare baseline (a markup of 185%). 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.
Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Emanate Health | $9 - $49 | 26% |
| Aids Health Foundation | $11 - $39 | 31% |
| Altamed Health Network | $11 - $39 | 31% |
| Avanti | $11 - $47 | 31% |
| Beverly Hospital | $11 - $43 | 31% |
| Brand New Day | $11 - $49 | 31% |
| Health Net Foundation | $11 - $172 | 31% |
| Healthy Way La | $11 | 31% |
| La Care Health Plan | $11 - $158 | 31% |
| Other Non Contracted Medi-Cal Hmo | $11 | 31% |
| State Of California | $11 | 31% |
| Allied Physicians | $13 - $58 | 37% |
| Associated Hispanic Physicians | $13 - $39 | 37% |
| Caloptima | $13 | 37% |
| Hollywood Presbyterian Adv Med Mcal | $13 | 37% |
| Hollywood Presbyterian Medpoint Mcal | $13 | 37% |
| Care 1St Medi Cal Hmo Cap Exceptional Care | $14 - $29 | 40% |
| Blue Cross Blue Shield | $16 - $223 | 46% |
| Clinica Medica Familiar | $16 - $144 | 46% |
| In Custody-Ca Highway Patrol | $20 | 57% |
| Central Health Plan | $23 - $201 | 66% |
| Bella Vista Medical Group Ipa | $27 - $129 | 77% |
| Employee Health Systems Medical Group | $27 - $57 | 77% |
| Global Care Medical Group Ipa | $27 - $129 | 77% |
| Veterans Administration | $27 | 77% |
| Intercomp | $30 | 86% |
| Interplan | $32 - $215 | 91% |
| Preferred Health Network | $32 | 91% |
| Athens Administrators | $33 | 94% |
| Multiplan | $33 - $244 | 94% |
| Other Non Contracted Work Comp | $33 | 94% |
| Alta Med Health Services Med Grp | $34 - $72 | 97% |
| Alignment Health Plan | $39 | 111% |
| Apa/Aco Inc | $39 | 111% |
| Blue Shield Of California | $39 - $433 | 111% |
| Champus Foundation | $39 | 111% |
| Cms | $39 | 111% |
| Cv-19 Hrsa Uninsured Testing And Tx I/P And O/P | $39 | 111% |
| Easy Choice Health Plan | $39 | 111% |
| Good Samaritan Medical Practice Assoc | $39 - $172 | 111% |
| Health Net Inc | $39 - $234 | 111% |
| La Care Covered Direct | $39 | 111% |
| Other Non Contracted Senior Hmo | $39 | 111% |
| Pacific Alliance Medical Center Reciprocal Contract | $39 | 111% |
| Pacificare Of California | $39 - $249 | 111% |
| Scan Health Plan | $39 | 111% |
| Self-Pay | $39 | 111% |
| UnitedHealthcare | $39 - $246 | 111% |
| Ahmc Reciprocity Agreement | $41 - $86 | 117% |
| Ahmc Reciprocity Agreement Senior/Commercial | $41 - $86 | 117% |
| Inter Valley Health Plan | $41 | 117% |
| Lincoln Hospital Medical Center | $41 - $86 | 117% |
| Molina Healthcare | $41 | 117% |
| Molina Healthcare Of California | $41 - $112 | 117% |
| San Miguel Health Plan | $43 | 123% |
| Chinatown Service Center Pace | $46 | 131% |
| Ahmc Health Self-Insurance Epo | $49 | 140% |
| Knox-Keene Act | $49 | 140% |
| Allied Physicians Medical Group | $60 | 171% |
| California Thoroughbred Horesmans Foundation | $68 - $144 | 194% |
| Universal Care | $68 - $201 | 194% |
| Care 1St Health Plan | $82 - $172 | 234% |
| Cost Containment Strategies | $88 - $187 | 251% |
| In Custody Police Dept | $88 - $187 | 251% |
| Community Care Network | $109 - $230 | 311% |
| Health Payors Organization | $122 - $258 | 348% |
| Cigna | $136 - $287 | 388% |
| Commercial Non Contract | $136 - $287 | 388% |
| Medi-Cal Sub Acute | $136 - $287 | 388% |
| Nuclear Medicine/Whmc | $136 - $287 | 388% |
| One Legacy | $136 - $287 | 388% |