CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Los Robles Hospital & Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $36
Cash Discount Price: $292
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Los Robles Hospital & Medical Center is $36. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $292. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.11x the Medicare baseline. Located in 215 W Janss Rd, Thousand Oaks, CA.

Cash / Self-Pay

$292

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: $292 (901%)

Insurance Median: $36 (111%)

Cash: $292 (901% 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
Aetna	$31 - $292	96%
Alignment Health Plan	$32 - $36	99%
Blue Cross Blue Shield	$32 - $36	99%
Blue Shield	$32 - $256	99%
Brand New Day	$32 - $36	99%
Care1St Health Plan	$32 - $37	99%
Central Health Plan	$32 - $36	99%
Clever Care Of Golden State	$32 - $36	99%
Easy Choice Health Plan	$32 - $36	99%
Facey Medical Group	$32 - $47	99%
Humana	$32 - $36	99%
La Care	$32 - $36	99%
Scan Health Plan	$32 - $36	99%
Triwest Healthcare Alliance	$32 - $36	99%
United	$32 - $82	99%
Health Net	$35 - $119	108%
Corvel Corporation	$37 - $42	114%
Ventura County Foundation	$37 - $263	114%
Medcare Partners	$44	136%
Bright Health	$81	250%
First Health	$199 - $234	614%
Choicecare Network	$205	633%
Multiplan	$234 - $278	722%
Ppo Next	$234	722%
Interplan Corporation	$263	812%

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 $292.
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 Los Robles Hospital & 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.