CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adventist Health White Memorial Montebello

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $36
Cash Discount Price: $36
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health White Memorial Montebello is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $36. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.11x the Medicare baseline. Located in 309 W Beverly Blvd, Montebello, CA.

Cash / Self-Pay

$36

Average discount available for prompt cash payment at this facility.

Insurance Median

$36

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: $36 (111%)

Insurance Median: $36 (111%)

Cash: $36 (111% of Medicare)

Ins. Median: $36 (111% 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
Altamed Mcal	$8	25%
Bc Mcal	$8	25%
Blue Shield Promise Mcal	$8	25%
Brand New Day Mcal	$8	25%
Healthnet Mcal	$8	25%
Kaiser Mcal	$8	25%
La Care Mcal	$8	25%
Medi-Cal	$8	25%
Molina Mcal - All Plans	$8	25%
Aetna	$36 - $75	111%
Alignment Health Plan-All Plans	$36	111%
Altamed Mcare-All Other Plans	$36	111%
Blue Shield Mcare Adv	$36	111%
Brand New Day Mcare-All Other Plans	$36	111%
Brandman Health Plan-All Plans	$36	111%
Caremore-All Plans	$36	111%
Clever Care Hp-All Plans	$36	111%
Easy Choice Mcare Adv-All Plans	$36	111%
Healthnet Med Adv	$36	111%
Kaiser Mcare Adv	$36	111%
Scan Health-All Plans	$36	111%
Oscar-All Plans	$38	117%
Blue Shield Epn Ifp	$41	127%
Healthnet Salud	$55 - $61	170%
Cigna	$66	204%
Healthnet Comm-All Other Plans	$66 - $74	204%
Blue Cross Blue Shield	$147	454%
Healthcare Partners-All Plans	$160	494%
UnitedHealthcare	$181	559%
Blue Shield Epn Core	$209	645%
Blue Shield Comm - All Other Plans	$217	670%

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 $36.
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 Adventist Health White Memorial Montebello 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.