CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Loma Linda University Children's Hospital

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $198
Cash Discount Price: $130
vs. Medicare Baseline: 6.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Loma Linda University Children's Hospital is $198. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $130. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 6.11x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$130

Average discount available for prompt cash payment at this facility.

Insurance Median

$198

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: $130 (401%)

Insurance Median: $198 (611%)

Cash: $130 (401% of Medicare)

Ins. Median: $198 (611% 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 611% of the Medicare baseline (a markup of 511%). 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
Inland Empire Health Plan (Iehp)	$9	28%
Kaiser Foundation Hospitals	$10 - $193	31%
Adventist Health	$58 - $118	179%
Lluh Dept Of Risk Management	$69	213%
Epic Health Plan	$116	358%
Alpha Care Medical Group	$159 - $246	491%
Global Benefits Group	$173	534%
Temecula Valley Physicians Medical Group	$173	534%
Trivalley Medical Group	$173	534%
Cigna	$185 - $214	571%
Networks By Design	$188	580%
Aetna	$190	586%
Molina Healthcare Of Ca	$202	623%
UnitedHealthcare	$206 - $417	636%
Multiplan	$231	713%
Dignity Health	$246	759%
Galaxy Health	$246	759%
Prime Health Services	$246	759%
Vantage Medical Group	$246	759%
Blue Shield Of California	$279 - $421	861%
Blue Cross Blue Shield	$457	1410%

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 $130.
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 Loma Linda University Children's 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.