CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Coalinga Regional Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)
  • CPT Billing Code: 97530
  • Insurance Median: $29
  • Cash Discount Price: $75
  • vs. Medicare Baseline: 0.83x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Coalinga Regional Medical Center is $29. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $75. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 0.83x the Medicare baseline. Located in 1191 Phelps Avenue, Coalinga, CA.
Cash / Self-Pay
$75

Average discount available for prompt cash payment at this facility.

Insurance Median
$29

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: $75 (214%)
Insurance Median: $29 (83%)
Cash: $75 (214% of Medicare)
Ins. Median: $29 (83% 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

Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash 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
Blue Cross Blue Shield $16 - $25 46%
Healthnet Mcal $16 46%
Medi-Cal $16 46%
Healthnet Mcr Adv $25 71%
Department Of State Hosp - All Plans $32 91%
Healthnet Prison $32 91%
Healthnet Hmo/Ppo - All Other Plans $56 160%
Cigna $87 248%
Aetna $106 302%

Self-Pay Upfront Cash Action Plan

Insurance In-Network Protection Plan

Facility Profile & Credentials

  • Address: 1191 Phelps Avenue, Coalinga, CA 93210
  • CMS Rating: No CMS Rating
  • Ownership Type: Government - Hospital District or Authority
  • Hospital Type: Critical Access Hospitals