CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Valley Presbyterian Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $88
Cash Discount Price: $147
vs. Medicare Baseline: 2.72x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Valley Presbyterian Hospital is $88. 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 $32.4, this hospital’s rate is 2.72x the Medicare baseline. Located in 15107 Vanowen St, Van Nuys, CA.

Cash / Self-Pay

$147

Average discount available for prompt cash payment at this facility.

Insurance Median

$88

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: $147 (454%)

Insurance Median: $88 (272%)

Cash: $147 (454% of Medicare)

Ins. Median: $88 (272% 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 272% of the Medicare baseline (a markup of 172%). 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
Blue Shield Promise Medi-Cal	$31 - $40	96%
Blue Shield Senior	$35	108%
Aetna	$36 - $92	111%
Blue Cross Blue Shield	$36 - $143	111%
Health Net Senior	$36	111%
La Care Covered California	$36	111%
Medicare (plans)	$36 - $38	111%
Ambetter / Centene	$51	157%
Heritage Provider Network (Regal & Lakeside)	$56	173%
Cigna	$66 - $86	204%
Health Net	$71	219%
La Care Medi-Cal	$74 - $97	228%
Phcs	$74 - $97	228%
Coventry Health Care (Ccn)	$86 - $113	265%
UnitedHealthcare	$88 - $253	272%
Beech Street	$92 - $121	284%
Multiplan	$111 - $145	343%
Blue Shield Ifp	$261	806%
Blue Shield	$299	923%

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 $147.
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 Valley Presbyterian 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.