CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adventist Health Castle

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $99
Cash Discount Price: $50
vs. Medicare Baseline: 3.06x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health Castle is $99. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $50. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.06x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$50

Average discount available for prompt cash payment at this facility.

Insurance Median

$99

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: $50 (154%)

Insurance Median: $99 (306%)

Cash: $50 (154% of Medicare)

Ins. Median: $99 (306% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 306% of the Medicare baseline (a markup of 206%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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
UnitedHealthcare	$19	59%
Kfh Mcr Adv	$35	108%
Medicare (plans)	$35	108%
Ohana Health Plan - All Plans	$35	108%
Devoted Hlth Mcr Adv - All Plans	$36	111%
Alohacare Quest Mcaid - All Other Plans	$39	120%
Hmsa Hmo	$41	127%
Hmsa Ppo - All Other Plans	$41	127%
Pacific Admin Ppo - All Plans	$99	306%
Hwmg/Hmaa - All Plans	$115	355%
Health Alliance - All Plans	$125	386%
Mdx Hawaii Ppo - All Plans	$125	386%
Kfh - All Other Plans	$133	410%
Uni Health Alliance - All Plans	$146	451%
First Health Ppo - All Plans	$147	454%
Medicaid / KanCare	$156	481%
State Of Hi Nonprofit - All Plans	$273	843%

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 $50.
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 Castle 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.