CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Adventist Health White Memorial
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $121
- Cash Discount Price: $56
- vs. Medicare Baseline: 3.73x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health White Memorial is $121. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $56. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.73x the Medicare baseline. Located in 1720 Cesar E Chavez Avenue, Los Angeles, CA.
Cash / Self-Pay
$56
Average discount available for prompt cash payment at this facility.
Insurance Median
$121
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: $56 (173%)
Insurance Median: $121 (373%)
Cash: $56 (173% of Medicare)
Ins. Median: $121 (373% 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 373% of the Medicare baseline (a markup of 273%). 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 |
|---|---|---|
| Bc Medi-Cal | $7 | 22% |
| Access Medi-Cal | $8 | 25% |
| Ahp Medi-Cal | $8 | 25% |
| Alta Los Angeles Mcal 1/1/19 | $8 | 25% |
| Avanti Mcal | $8 | 25% |
| Healthcare Inc Medi-Cal | $8 | 25% |
| Lasalle Mg Medi-Cal | $8 | 25% |
| Medi-Cal | $8 | 25% |
| Molina Medi-Cal | $8 | 25% |
| Pacific Alliance Medi-Cal | $8 | 25% |
| Pacific Ipa Medi-Cal | $8 | 25% |
| Preferred Ipa La Care Mcal Cap | $8 | 25% |
| Preferred Medi-Cal | $8 | 25% |
| Altamed Medi-Cal - All Other Plans | $9 | 28% |
| Fcs Ipa Medi-Cal Op/Profee Only | $9 | 28% |
| Healthnet Mcal | $9 | 28% |
| Preferred Healthy | $10 | 31% |
| Assoc Hispanic Physcns Mcal | $11 | 34% |
| Blue Shield Medi-Cal | $19 | 59% |
| Care First Medi-Cal | $27 | 83% |
| Access Group | $31 | 96% |
| Ahp - All Other Plans | $31 | 96% |
| Lasalle Mg Commercial - All Other Plans | $31 | 96% |
| Access Senior - All Other Plans | $36 | 111% |
| Ahp Senior | $36 | 111% |
| Alta Los Angeles Mcr 1/1/19-All Other Plans | $36 | 111% |
| Altamed Connect | $36 | 111% |
| Avanti Mcr Adv - All Other Plans | $36 | 111% |
| Brand New Day Mcare - All Plans | $36 | 111% |
| Bs Va Mcare | $36 | 111% |
| Care First Mcare - All Other Plans | $36 | 111% |
| Clever Care - All Plans | $36 | 111% |
| Fcs Ipa Mcr Advan Op/Profee Only | $36 | 111% |
| Humana | $36 | 111% |
| Lasalle Mg Senior | $36 | 111% |
| Medicare (plans) | $36 | 111% |
| Molina Mcare | $36 | 111% |
| Pacific Alliance Mcare - All Other Plans | $36 | 111% |
| Preferred Senior | $36 | 111% |
| Sunlight Living Hlth Mcr Adv-All Other Plans | $36 | 111% |
| Tricare | $36 | 111% |
| UnitedHealthcare | $36 - $188 | 111% |
| Blue Cross Blue Shield | $37 - $549 | 114% |
| Fcs Ipa Op/Profee Only - All Other Plans | $38 | 117% |
| Bright Health - All Plans | $41 | 127% |
| Assoc Hispanic Physcns Hmo/Mcr Adv-All Other Plans | $43 | 133% |
| Preferred Commercial - All Other Plans | $43 | 133% |
| Intergrated Medical - All Plans | $47 | 145% |
| Molina Benefit Exchange - All Other Plans | $49 | 151% |
| Php-Prospect Health Plan Cap - All Plans | $54 | 167% |
| Ah Employee Health Plan - All Plans | $65 | 201% |
| Bella Vista Mcr Adv Op/Profee Only - All Other Pla | $80 | 247% |
| Bella Vista Medi-Cal Op/Profee Only | $80 | 247% |
| Centivo - All Plans | $81 | 250% |
| Blue Shield Mcr Adv | $105 | 324% |
| Pacific Ipa - All Other Plans | $113 - $123 | 349% |
| Aetna | $114 | 352% |
| Kaiser- All Plans | $122 - $132 | 377% |
| Cigna | $126 - $137 | 389% |
| Healthnet - All Other Plans | $135 - $146 | 417% |
| Healthnet Comm Care | $139 - $151 | 429% |
| Hcpamg - All Plans | $149 - $162 | 460% |
| Caremore Mcare - All Plans | $154 | 475% |
| Healthcare Inc - All Other Plans | $164 - $178 | 506% |
| La Care Mcr Adv - All Plans | $164 - $178 | 506% |
| First Heatlh Ppo - All Plans | $173 - $187 | 534% |
| Phcs Ppo - All Plans | $194 - $210 | 599% |
| Scan Health Mcare - All Plans | $194 - $210 | 599% |
| Ahf - All Plans | $224 - $242 | 691% |
| Beech Street - All Plans | $224 - $242 | 691% |
| Interplan Ppo - All Plans | $224 - $242 | 691% |
| Corvel Corp - All Plans | $238 - $258 | 735% |
| Multiplan Ppo - All Plans | $247 - $268 | 762% |
| Healthmannet - All Plans | $253 - $275 | 781% |
| Next Inc Ppo - All Plans | $253 - $275 | 781% |
| Trpn - All Plans | $253 - $275 | 781% |
| Fpn Ppo - All Plans | $268 - $291 | 827% |
| Western Growers/Pinnacle - All Plans | $341 | 1052% |
| Healthnet Mcr Adv | $456 - $494 | 1407% |
| Blue Shield Epn | $460 | 1420% |
| Blue Shield - All Other Plans | $530 | 1636% |