Occupational therapy (self-care training)
Facility: Casa Colina Hospital
Billing Code: 97535 (CPT)
- CPT Billing Code: 97535
- Insurance Median: $130
- Cash Discount Price: $47
- vs. Medicare Baseline: 4.01x 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 $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 401% of the Medicare baseline (a markup of 301%). 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 |
|---|---|---|
| Kaiser Mcal | $8 | 25% |
| Medi-Cal | $8 | 25% |
| Prospect Hp Mcal | $32 | 99% |
| Promed Hlth Ntwrk Op Only - All Plans | $34 | 105% |
| Aetna | $36 - $43 | 111% |
| Blue Cross Blue Shield | $36 - $197 | 111% |
| Blue Shield Mcr Adv | $36 | 111% |
| Caremore Mcr Adv - All Plans | $36 | 111% |
| Central Hlth Plan - All Plans | $36 | 111% |
| Healthnet Mcr Adv | $36 | 111% |
| Humana | $36 - $137 | 111% |
| Iehp - All Other Plans | $36 | 111% |
| Kaiser Mcr Adv | $36 | 111% |
| Prospect Hp Mcr Adv | $36 | 111% |
| UnitedHealthcare | $36 - $158 | 111% |
| Wellcare Mcr Adv - All Plans | $36 | 111% |
| Prospect Hp Comm - All Other Plans | $40 | 123% |
| Three Rivers - All Plans | $56 | 173% |
| Tricare | $67 | 207% |
| Galaxy Provdr Ntwrk - All Plans | $78 | 241% |
| Iehp Mcal | $115 | 355% |
| Heritage Prvdr Ntwrk Mcal | $118 | 364% |
| Epic Comm - All Other Plans | $130 | 401% |
| Epic Mcr Adv | $130 | 401% |
| Iehp Mcr Adv | $130 | 401% |
| Primecare Comm - All Other Plans | $130 | 401% |
| Primecare Mcr Adv | $130 | 401% |
| Capital Hlth Phys Op Only - All Plans | $135 | 417% |
| Doctors Managed Op Only - All Plans | $135 | 417% |
| Empire Healthcare Op Only - All Plans | $135 | 417% |
| Focus Healthcare Wc - All Plans | $135 | 417% |
| Healthcare Partners - All Other Plans | $135 | 417% |
| Healthcare Partners Mcr | $135 | 417% |
| Premiercare Op Only - All Plans | $135 | 417% |
| Paramount Ipa Op Only - All Plans | $138 | 426% |
| Primecare Chino Valley Mcr | $138 | 426% |
| Heritage Prvdr Ntwrk Comm - All Other Plans | $140 | 432% |
| Heritage Prvdr Ntwrk Mcr | $140 | 432% |
| Advanced Med Dr Op Only - All Plans | $150 | 463% |
| Brand New Day Mcr Adv - All Plans | $150 | 463% |
| Primecare Chino Valley Comm | $150 | 463% |
| Kaiser Comm - All Other Plans | $154 | 475% |
| Prospect Med Grp Alta - All Plans | $155 | 478% |
| Healthnet Comm - All Other Plans | $156 | 481% |
| Cigna | $172 | 531% |
| Affiliated Hlth Funds - All Plans | $178 | 549% |
| Blue Shield Comm - All Other Plans | $179 | 552% |
| Corvel - All Plans | $219 | 676% |
| Coventry - All Plans | $219 | 676% |
| Multiplan - All Plans | $219 | 676% |
| Triwest - All Plans | $1,700 | 5247% |