CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Loma Linda University Children's Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $122
Cash Discount Price: $105
vs. Medicare Baseline: 3.48x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Loma Linda University Children's Hospital is $122. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $105. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.48x the Medicare baseline. Located in 11234 Anderson Street Suite A, Loma Linda, CA.

Cash / Self-Pay

$105

Average discount available for prompt cash payment at this facility.

Insurance Median

$122

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$35.07

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $35.07 (100%)

Cash / Self-Pay: $105 (299%)

Insurance Median: $122 (348%)

Cash: $105 (299% of Medicare)

Ins. Median: $122 (348% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $35.07 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 348% of the Medicare baseline (a markup of 248%). 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)	$19	54%
Kaiser Foundation Hospitals	$21 - $215	60%
Adventist Health	$29 - $132	83%
Lluh Dept Of Risk Management	$34 - $78	97%
Epic Health Plan	$57 - $129	163%
Alpha Care Medical Group	$79 - $275	225%
Global Benefits Group	$86 - $194	245%
Temecula Valley Physicians Medical Group	$86 - $194	245%
Trivalley Medical Group	$86 - $194	245%
Cigna	$92 - $239	262%
Networks By Design	$93 - $210	265%
Aetna	$94 - $212	268%
Molina Healthcare Of Ca	$100 - $226	285%
Multiplan	$114 - $258	325%
Dignity Health	$122 - $275	348%
Galaxy Health	$122 - $275	348%
Prime Health Services	$122 - $275	348%
Vantage Medical Group	$122 - $275	348%
UnitedHealthcare	$206 - $417	587%
Blue Shield Of California	$279 - $421	796%
Blue Cross Blue Shield	$457	1303%

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 $105.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97530.

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 97530.
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.