CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Watsonville Community Hospital
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $146
- Cash Discount Price: $147
- vs. Medicare Baseline: 4.16x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Watsonville Community Hospital is $146. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $147. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.16x the Medicare baseline. Located in 75 Nielson Street, Watsonville, CA.
Cash / Self-Pay
$147
Average discount available for prompt cash payment at this facility.
Insurance Median
$146
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: $147 (419%)
Insurance Median: $146 (416%)
Cash: $147 (419% of Medicare)
Ins. Median: $146 (416% 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 416% of the Medicare baseline (a markup of 316%). 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.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Ccs/Monterey County | $14 - $17 | 40% |
| Healthy Families | $14 - $17 | 40% |
| Well Path | $14 - $245 | 40% |
| Medicaid / KanCare | $14 - $17 | 40% |
| Medi-Cal E.R. | $14 - $17 | 40% |
| California Childrens Srvs | $14 - $17 | 40% |
| Medi-Cal/Eds | $14 - $17 | 40% |
| Alliance/Sccho | $17 - $28 | 48% |
| Secure Horizons | $40 | 114% |
| Medicare (plans) | $40 - $41 | 114% |
| UnitedHealthcare | $40 - $147 | 114% |
| Secure Horizons Dign HMO | $40 - $49 | 114% |
| Alignment Health Plan | $40 | 114% |
| Health Net of California | $40 - $153 | 114% |
| Beta Healthcare Group | $41 | 117% |
| Liberty Mutual Work Comp | $41 | 117% |
| Blue Shield PPO | $41 | 117% |
| Keenan & Assoc Work Comp | $41 | 117% |
| Kemper Group Workers Comp | $41 | 117% |
| Workers Comp | $41 | 117% |
| Tricare | $41 | 117% |
| Gallagher Bassett Svcs | $41 | 117% |
| Miscellaneous Work Comp | $41 | 117% |
| Fleming & Associates | $41 | 117% |
| Travelers Insurance | $41 - $245 | 117% |
| Veterans Administration | $41 | 117% |
| Ace-Usa | $41 | 117% |
| Fireman's Fund Work Comp | $41 | 117% |
| Crawford & Co | $41 | 117% |
| Pinnacle Healthcare Uc | $41 | 117% |
| Western Growers Work Comp | $41 | 117% |
| U.S. Dept. of Labor | $41 | 117% |
| Hartford Workers' Comp | $41 | 117% |
| Republic Idemnity W/Comp | $41 | 117% |
| Medicruz | $44 | 125% |
| Victim Compensation Plan | $44 - $245 | 125% |
| Health Net Pmg HMO | $49 - $153 | 140% |
| Blue Shield HMO | $49 | 140% |
| Cigna | $49 - $171 | 140% |
| Great-West/Phcs | $49 - $171 | 140% |
| Pacificare HMO | $49 - $147 | 140% |
| Aetna | $49 - $201 | 140% |
| Blue Cross Blue Shield | $49 - $218 | 140% |
| Western Growers Trust/Bc | $98 - $218 | 279% |
| Pinnacle Claims Tpa/Bc | $98 - $218 | 279% |
| Western Health Advantage | $122 | 348% |
| Kaiser Northern | $134 | 382% |
| Pacificare PPO | $147 | 419% |
| Health Net Smartcare Netw | $147 | 419% |
| Self Pay | $147 | 419% |
| Health Net Canopycare HMO | $153 | 436% |
| Health Net Blue and Gold | $153 | 436% |
| First Health | $171 - $196 | 488% |
| Transwestern | $171 - $196 | 488% |
| Adventist Risk Management | $171 - $196 | 488% |
| Geha (Ccn) | $171 - $196 | 488% |
| Multiplan Inc PPO | $191 | 545% |
| Private Healthcare System | $191 | 545% |
| Salinas Valley Mem Hops | $208 | 593% |
| Coastal Healthcare Admin | $208 - $220 | 593% |
| Monterey Bay Pub Emp Trst | $212 - $218 | 605% |
| Laborers Health & Welfare | $212 - $218 | 605% |
| State Compensation Fund | $212 - $218 | 605% |
| Calif Ironworkers Field | $212 - $218 | 605% |
| Delta Health Systems | $212 - $218 | 605% |
| City of Wats/Pinnacle Clm | $212 - $218 | 605% |
| Sheet Metal Workers | $212 - $218 | 605% |
| Operating Engineers | $212 - $218 | 605% |
| Robert Kennedy/Ccn | $212 - $218 | 605% |
| Claims Management Wc | $212 - $218 | 605% |
| Carpenters H&W Trust | $212 - $218 | 605% |
| Teamsters Benefit Trust | $212 - $218 | 605% |
| Sutter Health Plus | $245 | 699% |
| Allstate | $245 | 699% |
| Aaa | $245 | 699% |
| North Calif Bakery Driver | $245 | 699% |
| State Farm Ins | $245 | 699% |
| Wholesale Beer Distributo | $245 | 699% |
| Miscellaneous Insurance | $245 | 699% |
| Bankers Life & Casualty | $245 | 699% |
| United Administrative | $245 | 699% |
| Physicians Mutual | $245 | 699% |
| Humana | $245 | 699% |
| Miscellaneous Auto | $245 | 699% |
| Aarp | $245 | 699% |
| Prucare Pmg POS | $245 | 699% |
| Zenith National Ins | $245 | 699% |
| Prucare Pmg HMO | $245 | 699% |
| Apwu Health Plan | $245 | 699% |
| Farmers Insurance | $245 | 699% |