CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: City of Hope National Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $100
Cash Discount Price: $111
vs. Medicare Baseline: 3.09x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at City of Hope National Medical Center is $100. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $111. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 3.09x the Medicare baseline. Located in 1500 Duarte Rd, Duarte, CA.

Cash / Self-Pay

$111

Average discount available for prompt cash payment at this facility.

Insurance Median

$100

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: $111 (343%)

Insurance Median: $100 (309%)

Cash: $111 (343% of Medicare)

Ins. Median: $100 (309% 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 309% of the Medicare baseline (a markup of 209%). 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
Health Net	$29 - $141	90%
Cal Optima	$36	111%
Heritage Provider Network	$45 - $84	139%
Inland Empire	$45 - $96	139%
Blue Cross Blue Shield	$51 - $240	157%
UnitedHealthcare	$57 - $240	176%
Blue Shield	$61 - $240	188%
Prime Healthcare Keenan	$63 - $115	194%
Blue Shield Promise	$72 - $84	222%
Cencal	$82 - $96	253%
La Care Health	$82 - $96	253%
Kaiser	$92 - $108	284%
Aetna	$102 - $120	315%
Gold Coast	$102 - $120	315%
Molina	$102 - $156	315%
Cigna	$110 - $129	340%
Facey	$113 - $132	349%
Healthcare Partners	$119 - $139	367%
St. Joseph Heritage	$123 - $144	380%
Primecare Medical Network	$133 - $156	410%
First Health	$158 - $185	488%
Phcs Multiplan	$184 - $216	568%
Blue Shield Covca	$205 - $238	633%

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 $111.
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 City of Hope National Medical Center 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.