CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Adventist Health Castle

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $105
Cash Discount Price: $53
vs. Medicare Baseline: 2.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Adventist Health Castle is $105. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.99x the Medicare baseline. Located in 640 Ulukahiki St, Kailua, HI.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$105

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: $53 (151%)

Insurance Median: $105 (299%)

Cash: $53 (151% of Medicare)

Ins. Median: $105 (299% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 299% of the Medicare baseline (a markup of 199%). 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	$18	51%
Kfh Mcr Adv	$38	108%
Medicare (plans)	$38	108%
Ohana Health Plan - All Plans	$38	108%
Devoted Hlth Mcr Adv - All Plans	$40	114%
Alohacare Quest Mcaid - All Other Plans	$41	117%
Hmsa Hmo	$41	117%
Hmsa Ppo - All Other Plans	$41	117%
Pacific Admin Ppo - All Plans	$105	299%
Hwmg/Hmaa - All Plans	$121	345%
Health Alliance - All Plans	$132	376%
Mdx Hawaii Ppo - All Plans	$132	376%
Kfh - All Other Plans	$140	399%
Uni Health Alliance - All Plans	$154	439%
First Health Ppo - All Plans	$155	442%
Medicaid / KanCare	$165	470%
State Of Hi Nonprofit - All Plans	$289	824%

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 $53.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

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 97530.
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.