CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Coastal Communities Hospital
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $36
- Cash Discount Price: $40
- vs. Medicare Baseline: 1.11x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Coastal Communities Hospital is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $40. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.11x the Medicare baseline. Located in 2701 S Bristol St, Santa Ana, CA.
Cash / Self-Pay
$40
Average discount available for prompt cash payment at this facility.
Insurance Median
$36
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: $40 (123%)
Insurance Median: $36 (111%)
Cash: $40 (123% of Medicare)
Ins. Median: $36 (111% 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.
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 |
|---|---|---|
| Altamed Mcal Hmo (Ancillary) | $5 | 15% |
| Healthcare Partners | $5 | 15% |
| Hollywood Presbyterian | $5 - $36 | 15% |
| Kaiser | $5 - $36 | 15% |
| Medi-Cal Hmo/Non Contract | $5 | 15% |
| Medicaid / KanCare | $5 | 15% |
| Kpc Healthcare Inc | $6 - $45 | 19% |
| Altamed Health Services | $7 - $36 | 22% |
| Caloptima | $7 - $36 | 22% |
| Choc Health Alliance | $7 | 22% |
| County Of Orange | $7 | 22% |
| Family Choice | $7 | 22% |
| Heritage Provider Network | $7 - $24 | 22% |
| Prospect Health Plan | $7 - $54 | 22% |
| Ihhi Reciprocity | $12 | 37% |
| First Health | $21 | 65% |
| Magellan | $24 | 74% |
| Cigna | $26 - $315 | 80% |
| Health Net | $26 - $62 | 80% |
| Multiplan | $28 - $33 | 86% |
| Networks By Design | $28 | 86% |
| Networks By Design Wc | $28 | 86% |
| Coventry Auto Network | $30 | 93% |
| Healthsmart | $30 | 93% |
| Interplan | $30 | 93% |
| Prime Health | $30 | 93% |
| Prime Health Srvs/Wc | $30 | 93% |
| Coventry Wc | $31 | 96% |
| Pnoa-Provider Network Of America | $32 | 99% |
| Prime Health Srvs | $32 - $41 | 99% |
| Three Rivers | $33 | 102% |
| Velocity National Provider Network Wc | $33 | 102% |
| Workers Comp State Of California | $33 | 102% |
| Champus | $34 | 105% |
| Prime Health Srvs/Network | $34 | 105% |
| Blue Shield | $36 - $137 | 111% |
| Central Health Plan Of California | $36 | 111% |
| Champion Health Plan | $36 | 111% |
| Choice Physicians Network | $36 | 111% |
| Citizens Choice Health Plan | $36 | 111% |
| Clever Care Health Plan | $36 | 111% |
| Easy Choice Health Plan | $36 | 111% |
| For Your Benefit | $36 | 111% |
| Healthcare Partners Sr Hmo | $36 | 111% |
| Heritage | $36 | 111% |
| Humana | $36 | 111% |
| Imperial Health Plan Of Ca | $36 | 111% |
| Innovative Integrated Health | $36 | 111% |
| Medcare Partners | $36 | 111% |
| Monarch | $36 - $167 | 111% |
| Onecare | $36 | 111% |
| Onecare Connect | $36 | 111% |
| Other Senior Non Contract | $36 | 111% |
| Scan Health Plan | $36 | 111% |
| Self Pay Ab774/Cbo Use Only | $36 | 111% |
| UnitedHealthcare | $36 - $220 | 111% |
| Us Dept Of Labor | $36 | 111% |
| Us Federal Marshall/Department Of Immigration | $36 | 111% |
| Velocity Provider Network Sr | $36 | 111% |
| Verda Health Plan Sr | $36 | 111% |
| Veterans Administration | $36 | 111% |
| Victim Of Violent Crime | $36 | 111% |
| Victoria Hospice | $36 | 111% |
| Brand New Day | $40 | 123% |
| Lucet Behavioral Health Sr | $40 | 123% |
| Managed Health Network | $40 | 123% |
| Other Insurance Loa | $40 | 123% |
| Other Non Contracted Plans | $40 | 123% |
| Private Pay | $40 | 123% |
| Us Behavioral Health Plan | $40 | 123% |
| Vitas Hospice | $40 | 123% |
| County Of Orange/Custody/Advanced Medmgt | $45 | 139% |
| Veterans Evaluation Services | $45 | 139% |
| Staywell/Island Home Ins | $50 | 154% |
| Three Rivers Network | $63 | 194% |
| Velocity National Provider Network Ppo | $63 | 194% |
| Aetna | $65 | 201% |
| Monarch Health Plan | $179 | 552% |