CMS Price Transparency Data
Occupational therapy (self-care training)
Facility: Children's Hosp of Los Angeles
Billing Code: 97535 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97535
- Insurance Median: $12
- Cash Discount Price: $17
- vs. Medicare Baseline: 0.37x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Children's Hosp of Los Angeles is $12. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $17. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 0.37x the Medicare baseline. Located in 4650 Sunset Blvd, Ms 108, Los Angeles, CA.
Cash / Self-Pay
$17
Average discount available for prompt cash payment at this facility.
Insurance Median
$12
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: $17 (52%)
Insurance Median: $12 (37%)
Cash: $17 (52% of Medicare)
Ins. Median: $12 (37% 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.
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 | $3 - $11 | 9% |
| Medi-Cal | $3 - $5 | 9% |
| Molina | $3 - $11 | 9% |
| Adventist Health Physicians | $4 - $51 | 12% |
| Intl - Global Excel Management | $4 - $57 | 12% |
| Medicaid / KanCare | $4 - $28 | 12% |
| Shriners Hospital | $4 - $8 | 12% |
| Beech Street | $5 - $11 | 15% |
| Cigna | $5 - $13 | 15% |
| Emanate Health Medical Center Mmc | $5 - $13 | 15% |
| Health Net | $5 - $35 | 15% |
| Incentive Health Network | $5 - $11 | 15% |
| Kaiser | $5 - $16 | 15% |
| Non-Contract Payors | $5 - $11 | 15% |
| Valley Presbyterian Hospital | $5 - $28 | 15% |
| Accarent Health | $6 - $14 | 19% |
| Aetna | $6 - $16 | 19% |
| Altamed | $6 - $28 | 19% |
| Applecare Medical Group | $6 - $519 | 19% |
| Axminster Medical Group | $6 - $100 | 19% |
| Bella Vista Med Grp | $6 - $108 | 19% |
| Blue Shield | $6 - $28 | 19% |
| Book Md | $6 - $15 | 19% |
| Centinela Valley Ipa | $6 - $108 | 19% |
| Choice Medical Group | $6 - $16 | 19% |
| Citrus Valley Phys Grp | $6 - $18 | 19% |
| Community Care | $6 - $16 | 19% |
| Culinary Health Fund | $6 - $28 | 19% |
| Exceptional Care Medical Group | $6 - $536 | 19% |
| Facey Medical Group | $6 - $100 | 19% |
| Gemcare Ipa | $6 - $14 | 19% |
| Global Care Medical Group | $6 - $108 | 19% |
| Good Samaritan Medical Group | $6 - $15 | 19% |
| Health Care La Ipa | $6 - $108 | 19% |
| Intl - Global Medical Management | $6 - $16 | 19% |
| Intl - Quality Health Management | $6 - $28 | 19% |
| La Care | $6 - $28 | 19% |
| Managed Care Systems | $6 - $14 | 19% |
| Mercy Care | $6 - $14 | 19% |
| National Healthcare Solutions | $6 - $16 | 19% |
| Pioneer Prov Ntwk | $6 - $14 | 19% |
| Premier Physicians Ntwk | $6 - $108 | 19% |
| Sansum Clinic | $6 - $14 | 19% |
| St Francis Medical Center | $6 - $28 | 19% |
| St. John'S Health Clinic | $6 - $100 | 19% |
| Staywell Insurance | $6 - $14 | 19% |
| UnitedHealthcare | $6 - $202 | 19% |
| Access Medical Group | $7 - $17 | 22% |
| Alhambra Hospital Medical Center | $7 - $28 | 22% |
| Allied Pacific Ipa | $7 - $28 | 22% |
| Blue Cross Blue Shield | $7 - $448 | 22% |
| Bright Medical Associates | $7 - $17 | 22% |
| Caloptima | $7 - $28 | 22% |
| Choc Health Alliance | $7 | 22% |
| Delta Health Systems | $7 - $17 | 22% |
| Emanate Health Medical Center Commercial | $7 - $17 | 22% |
| Family Care Specialists | $7 - $455 | 22% |
| Heritage Provider Network | $7 - $28 | 22% |
| Los Angeles Medical Center Ipa | $7 - $28 | 22% |
| Preferred Ipa - Commercial | $7 - $17 | 22% |
| Private Hlthcare System | $7 - $17 | 22% |
| Providence Health Network | $7 - $464 | 22% |
| Sanus Health | $7 - $17 | 22% |
| Self-Pay | $7 - $17 | 22% |
| Seoul Medical Group | $7 - $17 | 22% |
| Sierra Health And Life Insurance Company | $7 - $18 | 22% |
| Ventura County Health Plan | $7 - $628 | 22% |
| Angeles Ipa | $8 - $28 | 25% |
| Axis Services International | $8 - $18 | 25% |
| Beaver Medical Group | $8 - $20 | 25% |
| Calvo Selectcare | $8 - $18 | 25% |
| Cedar Sinai Med Grp | $8 - $18 | 25% |
| Community Family Care Ipa | $8 - $28 | 25% |
| El Proyecto Del Barrio | $8 - $108 | 25% |
| Embassy - Saudi Arabia | $8 - $18 | 25% |
| Hollywood Presbyterian Medical Center | $8 - $28 | 25% |
| Imperial Health Holdings Medical Group | $8 - $28 | 25% |
| Intl - Aixin Life Insurance Co | $8 - $28 | 25% |
| Intl - Concierge Healthcare Services | $8 - $18 | 25% |
| Intl - Erv Travel Services | $8 - $20 | 25% |
| Intl - Msh China Enterprise Services | $8 - $18 | 25% |
| Korean American Med Grp | $8 - $20 | 25% |
| Lakewood Health Plan | $8 - $18 | 25% |
| Marian Health Services | $8 - $18 | 25% |
| Memorialcare Med Foundation | $8 - $20 | 25% |
| Multiplan | $8 - $20 | 25% |
| Plotkin Health | $8 - $18 | 25% |
| Prime Health Services | $8 - $18 | 25% |
| Primecare Medical Network | $8 - $20 | 25% |
| Redlands Community Hospital | $8 - $18 | 25% |
| Seaside Health Plan | $8 - $28 | 25% |
| Serra Community Med Clinic - Commercial | $8 - $18 | 25% |
| Star Healthcare Network Commercial | $8 - $18 | 25% |
| Watts Healthcare Mmc | $8 - $108 | 25% |
| Associated Hispanic Physicians Ipa | $9 - $28 | 28% |
| Care 1St | $9 - $28 | 28% |
| Embassy - All Others | $9 - $23 | 28% |
| Embassy - Kuwait | $9 - $21 | 28% |
| Hispanic Physician Ipa | $9 - $28 | 28% |
| Interlink Health Services | $9 - $21 | 28% |
| Prospect Medical Group | $9 - $21 | 28% |
| Self-Pay International | $9 - $23 | 28% |
| Serendib Healthways Mmc | $9 - $150 | 28% |
| White Memorial Medical Center | $9 - $28 | 28% |
| Accountable Health | $10 - $142 | 31% |
| Avalon Ipa | $10 - $166 | 31% |
| Beverly Hospital | $10 - $28 | 31% |
| Cal Care Ipa | $10 - $28 | 31% |
| Cencal Health | $10 - $28 | 31% |
| Family Health Alliance Med Grp | $10 - $174 | 31% |
| Gold Coast Health Plan | $10 - $28 | 31% |
| Karing Physicians Medical Group | $10 - $178 | 31% |
| Mabuhay Medical Group | $10 - $166 | 31% |
| Noble Community Medical Associates | $10 - $178 | 31% |
| Pacific Alliance Medical Center | $10 - $28 | 31% |
| Preferred Ipa | $10 - $28 | 31% |
| Primary Care And Pediatric Ipa | $10 - $166 | 31% |
| Regent Medical Group | $10 - $178 | 31% |
| San Judas Med Grp | $10 - $28 | 31% |
| Souther California Hosp System - Mmc | $10 - $28 | 31% |
| Asian Community Medical Group | $11 - $208 | 34% |
| California Pacific Physicians Medical Group | $11 - $208 | 34% |
| Champus | $11 - $27 | 34% |
| Crown City Medical Group | $11 - $28 | 34% |
| Employee Health Systems Med Grp | $11 - $28 | 34% |
| Healthy New Life Medical Corp | $11 - $208 | 34% |
| Point Comfort Underwriters | $11 | 34% |
| Community Care Ipa Mmc | $12 - $167 | 37% |
| Dignity Health | $12 - $28 | 37% |
| Kern Family Health Plan | $12 - $28 | 37% |
| Medicare (plans) | $12 - $28 | 37% |
| Serra Community Med Clinic | $12 - $28 | 37% |
| Southern Atlantic Medical Group Mmc | $12 - $28 | 37% |
| Southland San Gabriel Valley Medical Group | $12 - $238 | 37% |
| Superior Choice Medical Group | $12 - $248 | 37% |