CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adventist Health Howard Memorial

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $50
Cash Discount Price: $47
vs. Medicare Baseline: 1.54x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health Howard Memorial is $50. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $47. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.54x the Medicare baseline. Located in 1 Marcela Dr, Willits, CA.

Cash / Self-Pay

$47

Average discount available for prompt cash payment at this facility.

Insurance Median

$50

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: $47 (145%)

Insurance Median: $50 (154%)

Cash: $47 (145% of Medicare)

Ins. Median: $50 (154% 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.

Billing Status

Remaining Deductible ($)

Your Coinsurance Rate (%)

Input your details and click calculate to compare out-of-pocket costs.

Commercial Insurance Negotiated Rates

Negotiated contract ranges established by major commercial carriers at this facility.

Carrier / Plan Group	Contract Rate Range	vs. Medicare Reference
Medi-Cal	$5 - $8	15%
Blue Shield Mcare	$17 - $46	52%
Medicare (plans)	$17 - $46	52%
Tricare	$17 - $46	52%
UnitedHealthcare	$18 - $178	56%
Aetna	$24 - $154	74%
Cigna	$37 - $196	114%
Ah Employee Health Plan - All Plans	$38 - $120	117%
Blue Shield - All Other Plans	$48 - $334	148%
Western Growers/Pinnacle - All Plans	$49 - $172	151%
Blue Cross Blue Shield	$50 - $598	154%
Healthnet - All Plans	$50 - $189	154%
First Health Ppo - All Plans	$67 - $184	207%
Ghn Ppo - All Plans	$67 - $184	207%
Brms - All Plans	$71 - $196	219%
Blue Shield Epn	$327	1009%

Self-Pay Upfront Cash Action Plan

Request a "Self-Pay classification" with the billing desk before receiving care.
Ask for a written "Prompt-Pay Discount" agreement quoting the price of $47.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Howard Memorial is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
Confirm the specific physician or imaging center is also in-network (not just the hospital building).
Audit your Explanation of Benefits (EOB) against the final itemized hospital invoice.