CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Watsonville Community Hospital
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $199
- Cash Discount Price: $163
- vs. Medicare Baseline: 6.14x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Watsonville Community Hospital is $199. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $163. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 6.14x the Medicare baseline. Located in 75 Nielson Street, Watsonville, CA.
Cash / Self-Pay
$163
Average discount available for prompt cash payment at this facility.
Insurance Median
$199
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: $163 (503%)
Insurance Median: $199 (614%)
Cash: $163 (503% of Medicare)
Ins. Median: $199 (614% 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 614% of the Medicare baseline (a markup of 514%). 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.
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 |
|---|---|---|
| Workers Comp | $36 | 111% |
| Travelers Insurance | $36 - $277 | 111% |
| UnitedHealthcare | $36 - $166 | 111% |
| Kemper Group Workers Comp | $36 | 111% |
| Secure Horizons Dign HMO | $36 - $55 | 111% |
| Miscellaneous Work Comp | $36 | 111% |
| Ace-Usa | $36 | 111% |
| Pinnacle Healthcare Uc | $36 | 111% |
| U.S. Dept. of Labor | $36 | 111% |
| Medicare (plans) | $36 | 111% |
| Hartford Workers' Comp | $36 | 111% |
| Beta Healthcare Group | $36 | 111% |
| Veterans Administration | $36 | 111% |
| Secure Horizons | $36 | 111% |
| Alignment Health Plan | $36 | 111% |
| Liberty Mutual Work Comp | $36 | 111% |
| Tricare | $36 | 111% |
| Fireman's Fund Work Comp | $36 | 111% |
| Western Growers Work Comp | $36 | 111% |
| Keenan & Assoc Work Comp | $36 | 111% |
| Crawford & Co | $36 | 111% |
| Gallagher Bassett Svcs | $36 | 111% |
| Republic Idemnity W/Comp | $36 | 111% |
| Fleming & Associates | $36 | 111% |
| Health Net of California | $36 - $174 | 111% |
| Blue Shield PPO | $36 | 111% |
| Victim Compensation Plan | $48 - $277 | 148% |
| Medicruz | $48 - $50 | 148% |
| Aetna | $53 - $227 | 164% |
| Pacificare HMO | $53 - $166 | 164% |
| Health Net Pmg HMO | $53 - $174 | 164% |
| Cigna | $53 - $194 | 164% |
| Great-West/Phcs | $53 - $194 | 164% |
| Blue Shield HMO | $53 - $55 | 164% |
| Blue Cross Blue Shield | $53 - $247 | 164% |
| Pinnacle Claims Tpa/Bc | $106 - $247 | 327% |
| Western Growers Trust/Bc | $106 - $247 | 327% |
| Kaiser Northern | $117 | 361% |
| Western Health Advantage | $133 - $139 | 410% |
| Self Pay | $159 - $166 | 491% |
| Pacificare PPO | $159 - $166 | 491% |
| Health Net Smartcare Netw | $159 - $166 | 491% |
| Health Net Canopycare HMO | $166 - $174 | 512% |
| Health Net Blue and Gold | $166 - $174 | 512% |
| Geha (Ccn) | $186 - $222 | 574% |
| First Health | $186 - $222 | 574% |
| Transwestern | $186 - $222 | 574% |
| Adventist Risk Management | $186 - $222 | 574% |
| Multiplan Inc PPO | $207 - $216 | 639% |
| Private Healthcare System | $207 - $216 | 639% |
| Salinas Valley Mem Hops | $225 - $236 | 694% |
| Coastal Healthcare Admin | $225 - $249 | 694% |
| Claims Management Wc | $230 - $247 | 710% |
| Sheet Metal Workers | $230 - $247 | 710% |
| State Compensation Fund | $230 - $247 | 710% |
| Calif Ironworkers Field | $230 - $247 | 710% |
| Monterey Bay Pub Emp Trst | $230 - $247 | 710% |
| Teamsters Benefit Trust | $230 - $247 | 710% |
| Delta Health Systems | $230 - $247 | 710% |
| Carpenters H&W Trust | $230 - $247 | 710% |
| Robert Kennedy/Ccn | $230 - $247 | 710% |
| Operating Engineers | $230 - $247 | 710% |
| City of Wats/Pinnacle Clm | $230 - $247 | 710% |
| Laborers Health & Welfare | $230 - $247 | 710% |
| Wholesale Beer Distributo | $265 - $277 | 818% |
| North Calif Bakery Driver | $265 - $277 | 818% |
| Humana | $265 - $277 | 818% |
| Miscellaneous Insurance | $265 - $277 | 818% |
| Zenith National Ins | $265 - $277 | 818% |
| Prucare Pmg POS | $265 - $277 | 818% |
| Allstate | $265 - $277 | 818% |
| State Farm Ins | $265 - $277 | 818% |
| Farmers Insurance | $265 - $277 | 818% |
| Prucare Pmg HMO | $265 - $277 | 818% |
| Apwu Health Plan | $265 - $277 | 818% |
| Aarp | $265 - $277 | 818% |
| United Administrative | $265 - $277 | 818% |
| Miscellaneous Auto | $265 - $277 | 818% |
| Sutter Health Plus | $265 - $277 | 818% |
| Bankers Life & Casualty | $265 - $277 | 818% |
| Physicians Mutual | $265 - $277 | 818% |
| Aaa | $265 - $277 | 818% |
| Well Path | $265 - $277 | 818% |