CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Santa Monica - UCLA Med Ctr & Orthopaedic Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $41
Cash Discount Price: Unavailable
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Santa Monica - UCLA Med Ctr & Orthopaedic Hospital is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.27x the Medicare baseline. Located in 1250 16Th Street, Santa Monica, CA.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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%)

Insurance Median: $41 (127%)

Ins. Median: $41 (127% 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.

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
La Care Medi-Cal Hmo	$5	15%
Aetna	$41	127%
Blue Shield	$41	127%
La Care Dsnp	$41	127%
Medicare (plans)	$41 - $45	127%
Monarch	$41	127%
St. Jude	$41	127%
Triwest Healthcare Alliance	$41	127%
UnitedHealthcare	$41 - $119	127%
Providence Healthcare	$45	139%
Central Health Plan	$49	151%
Healthsmart	$50	154%
Scan	$55	170%
La Care Covered Ca	$57	176%
Centivo	$99	306%
Health Plan Of Nevada Commercial	$114	352%

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 $X.
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 Santa Monica - UCLA Med Ctr & Orthopaedic Hospital 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.