CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Coastal Communities Hospital
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $39
- Cash Discount Price: $85
- vs. Medicare Baseline: 1.11x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Coastal Communities Hospital is $39. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $85. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.11x the Medicare baseline. Located in 2701 S Bristol St, Santa Ana, CA.
Cash / Self-Pay
$85
Average discount available for prompt cash payment at this facility.
Insurance Median
$39
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: $85 (242%)
Insurance Median: $39 (111%)
Cash: $85 (242% of Medicare)
Ins. Median: $39 (111% 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.
Out-of-Pocket Cost Estimator
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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 |
|---|---|---|
| Kpc Healthcare Inc | $13 - $49 | 37% |
| Altamed Mcal Hmo (Ancillary) | $16 | 46% |
| Healthcare Partners | $16 | 46% |
| Hollywood Presbyterian | $16 - $39 | 46% |
| Kaiser | $16 - $52 | 46% |
| Medi-Cal Hmo/Non Contract | $16 | 46% |
| Medicaid / KanCare | $16 | 46% |
| Altamed Health Services | $22 - $39 | 63% |
| Caloptima | $22 - $39 | 63% |
| Choc Health Alliance | $22 | 63% |
| County Of Orange | $22 | 63% |
| Family Choice | $22 | 63% |
| Heritage Provider Network | $22 - $51 | 63% |
| Prospect Health Plan | $22 - $59 | 63% |
| Ihhi Reciprocity | $26 | 74% |
| Coventry Auto Network | $30 | 86% |
| Interplan | $30 - $64 | 86% |
| Prime Health Srvs/Wc | $30 | 86% |
| Coventry Wc | $31 | 88% |
| Multiplan | $33 - $60 | 94% |
| Three Rivers | $33 | 94% |
| Velocity National Provider Network Wc | $33 | 94% |
| Workers Comp State Of California | $33 | 94% |
| Champus | $37 | 106% |
| Blue Shield | $39 - $149 | 111% |
| Central Health Plan Of California | $39 | 111% |
| Champion Health Plan | $39 | 111% |
| Choice Physicians Network | $39 | 111% |
| Citizens Choice Health Plan | $39 | 111% |
| Clever Care Health Plan | $39 | 111% |
| Easy Choice Health Plan | $39 | 111% |
| For Your Benefit | $39 | 111% |
| Health Net | $39 - $68 | 111% |
| Healthcare Partners Sr Hmo | $39 | 111% |
| Heritage | $39 | 111% |
| Humana | $39 | 111% |
| Imperial Health Plan Of Ca | $39 | 111% |
| Innovative Integrated Health | $39 | 111% |
| Medcare Partners | $39 | 111% |
| Monarch | $39 - $167 | 111% |
| Onecare | $39 | 111% |
| Onecare Connect | $39 | 111% |
| Other Senior Non Contract | $39 | 111% |
| Scan Health Plan | $39 | 111% |
| Self Pay Ab774/Cbo Use Only | $39 | 111% |
| UnitedHealthcare | $39 - $220 | 111% |
| Us Dept Of Labor | $39 | 111% |
| Us Federal Marshall/Department Of Immigration | $39 | 111% |
| Velocity Provider Network Sr | $39 | 111% |
| Verda Health Plan Sr | $39 | 111% |
| Veterans Administration | $39 | 111% |
| Victim Of Violent Crime | $39 | 111% |
| Victoria Hospice | $39 | 111% |
| Brand New Day | $44 | 125% |
| First Health | $45 | 128% |
| Prime Health Srvs | $45 - $68 | 128% |
| County Of Orange/Custody/Advanced Medmgt | $49 | 140% |
| Veterans Evaluation Services | $49 | 140% |
| Magellan | $51 | 145% |
| Cigna | $55 - $315 | 157% |
| Staywell/Island Home Ins | $55 | 157% |
| Networks By Design | $60 | 171% |
| Networks By Design Wc | $60 | 171% |
| Healthsmart | $64 | 182% |
| Prime Health | $64 | 182% |
| Aetna | $65 | 185% |
| Pnoa-Provider Network Of America | $68 | 194% |
| Three Rivers Network | $69 | 197% |
| Velocity National Provider Network Ppo | $69 | 197% |
| Prime Health Srvs/Network | $72 | 205% |
| Lucet Behavioral Health Sr | $85 | 242% |
| Managed Health Network | $85 | 242% |
| Other Insurance Loa | $85 | 242% |
| Other Non Contracted Plans | $85 | 242% |
| Private Pay | $85 | 242% |
| Us Behavioral Health Plan | $85 | 242% |
| Vitas Hospice | $85 | 242% |
| Monarch Health Plan | $179 | 510% |