CMS Price Transparency Data
Occupational therapy (therapeutic activities)
Facility: Children's Hosp of Los Angeles
Billing Code: 97530 (CPT)
Factual Cost Summary (Answer Capsule)
- CPT Billing Code: 97530
- Insurance Median: $40
- Cash Discount Price: $58
- vs. Medicare Baseline: 1.14x Medicare
The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Children's Hosp of Los Angeles is $40. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $58. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.14x the Medicare baseline. Located in 4650 Sunset Blvd, Ms 108, Los Angeles, CA.
Cash / Self-Pay
$58
Average discount available for prompt cash payment at this facility.
Insurance Median
$40
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: $58 (165%)
Insurance Median: $40 (114%)
Cash: $58 (165% of Medicare)
Ins. Median: $40 (114% 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.
Out-of-Pocket Cost Estimator
Estimate whether it is more economical to use your insurance or pay the upfront self-pay cash rate.
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Commercial Insurance Negotiated Rates
Negotiated contract ranges established by major commercial carriers at this facility.
| Carrier / Plan Group | Contract Rate Range | vs. Medicare Reference |
|---|---|---|
| Health Net | $4 - $106 | 11% |
| Southern Atlantic Medical Group Mmc | $5 - $85 | 14% |
| Adventist Health Physicians | $5 - $85 | 14% |
| Molina | $6 - $34 | 17% |
| Medi-Cal | $6 - $13 | 17% |
| Inland Empire Health Plan | $6 - $33 | 17% |
| Intl - Global Excel Management | $6 - $78 | 17% |
| Medicaid / KanCare | $12 - $85 | 34% |
| Shriners Hospital | $12 - $26 | 34% |
| Altamed | $14 - $85 | 40% |
| Non-Contract Payors | $16 - $34 | 46% |
| Valley Presbyterian Hospital | $16 - $85 | 46% |
| Beech Street | $16 - $34 | 46% |
| Caloptima | $16 - $85 | 46% |
| Incentive Health Network | $16 - $34 | 46% |
| La Care | $18 - $85 | 51% |
| Emanate Health Medical Center Mmc | $18 - $38 | 51% |
| Cigna | $19 - $40 | 54% |
| Facey Medical Group | $19 - $100 | 54% |
| Axminster Medical Group | $19 - $100 | 54% |
| Kaiser | $19 - $48 | 54% |
| St. John's Health Clinic | $19 - $100 | 54% |
| Sansum Clinic | $20 - $42 | 57% |
| Choc Health Alliance | $20 | 57% |
| Mercy Care | $20 - $42 | 57% |
| Staywell Insurance | $20 - $42 | 57% |
| Gemcare IPA | $20 - $42 | 57% |
| Managed Care Systems | $20 - $42 | 57% |
| Accarent Health | $20 - $42 | 57% |
| Citrus Valley Phys Grp | $20 - $55 | 57% |
| St Francis Medical Center | $20 - $85 | 57% |
| Pioneer Prov Ntwk | $20 - $42 | 57% |
| Aetna | $21 - $47 | 60% |
| Applecare Medical Group | $21 - $519 | 60% |
| Good Samaritan Medical Group | $21 - $45 | 60% |
| Book Md | $21 - $44 | 60% |
| Culinary Health Fund | $22 - $78 | 63% |
| Blue Shield | $22 - $85 | 63% |
| Choice Medical Group | $22 - $47 | 63% |
| Global Care Medical Group | $22 - $108 | 63% |
| National Healthcare Solutions | $22 - $47 | 63% |
| Bella Vista Med Grp | $22 - $108 | 63% |
| Centinela Valley IPA | $22 - $108 | 63% |
| Intl - Global Medical Management | $22 - $47 | 63% |
| Health Care La IPA | $22 - $108 | 63% |
| Community Care | $22 - $47 | 63% |
| Intl - Quality Health Management | $22 - $84 | 63% |
| Premier Physicians Ntwk | $22 - $108 | 63% |
| Blue Cross Blue Shield | $23 - $448 | 66% |
| Seoul Medical Group | $24 - $50 | 68% |
| Alhambra Hospital Medical Center | $24 - $85 | 68% |
| UnitedHealthcare | $24 - $202 | 68% |
| Heritage Provider Network | $24 - $85 | 68% |
| Access Medical Group | $24 - $50 | 68% |
| Hollywood Presbyterian Medical Center | $24 - $85 | 68% |
| Ventura County Health Plan | $24 - $628 | 68% |
| Allied Pacific IPA | $24 - $85 | 68% |
| Community Family Care IPA | $24 - $85 | 68% |
| Los Angeles Medical Center IPA | $24 - $85 | 68% |
| Emanate Health Medical Center Commercial | $24 - $51 | 68% |
| Private Hlthcare System | $24 - $51 | 68% |
| Bright Medical Associates | $24 - $51 | 68% |
| Delta Health Systems | $24 - $51 | 68% |
| Self-Pay | $24 - $51 | 68% |
| Family Care Specialists | $24 - $455 | 68% |
| Sanus Health | $24 - $51 | 68% |
| Preferred IPA - Commercial | $24 - $51 | 68% |
| Sierra Health and Life Insurance Company | $25 - $53 | 71% |
| Embassy - Saudi Arabia | $26 - $55 | 74% |
| Redlands Community Hospital | $26 - $55 | 74% |
| Axis Services International | $26 - $55 | 74% |
| Imperial Health Holdings Medical Group | $26 - $85 | 74% |
| Marian Health Services | $26 - $55 | 74% |
| Prime Health Services | $26 - $55 | 74% |
| Calvo Selectcare | $26 - $55 | 74% |
| Seaside Health Plan | $26 - $85 | 74% |
| Cedar Sinai Med Grp | $26 - $55 | 74% |
| Serra Community Med Clinic - Commercial | $26 - $55 | 74% |
| Intl - Aixin Life Insurance Co | $26 - $84 | 74% |
| Plotkin Health | $26 - $55 | 74% |
| Intl - Msh China Enterprise Services | $26 - $55 | 74% |
| Lakewood Health Plan | $26 - $55 | 74% |
| Star Healthcare Network Commercial | $26 - $55 | 74% |
| Intl - Concierge Healthcare Services | $26 - $55 | 74% |
| Intl - Erv Travel Services | $26 - $60 | 74% |
| Serra Community Med Clinic | $27 - $85 | 77% |
| Care 1St | $28 - $85 | 80% |
| Multiplan | $28 - $60 | 80% |
| Beaver Medical Group | $28 - $60 | 80% |
| Korean American Med Grp | $28 - $60 | 80% |
| Primecare Medical Network | $28 - $60 | 80% |
| Memorialcare Med Foundation | $28 - $60 | 80% |
| Angeles IPA | $28 - $85 | 80% |
| White Memorial Medical Center | $28 - $85 | 80% |
| Cal Care IPA | $29 - $85 | 83% |
| Hispanic Physician IPA | $30 - $85 | 86% |
| Embassy - Kuwait | $30 - $64 | 86% |
| Preferred IPA | $30 - $85 | 86% |
| San Judas Med Grp | $30 - $85 | 86% |
| Associated Hispanic Physicians IPA | $30 - $85 | 86% |
| Beverly Hospital | $30 - $85 | 86% |
| Pacific Alliance Medical Center | $30 - $85 | 86% |
| Gold Coast Health Plan | $30 - $85 | 86% |
| Interlink Health Services | $30 - $64 | 86% |
| Prospect Medical Group | $30 - $64 | 86% |
| Cencal Health | $31 - $85 | 88% |
| Souther California Hosp System - Mmc | $31 - $85 | 88% |
| Employee Health Systems Med Grp | $32 - $85 | 91% |
| Self-Pay International | $32 - $68 | 91% |
| Point Comfort Underwriters | $32 | 91% |
| Embassy - All Others | $32 - $68 | 91% |
| Crown City Medical Group | $32 - $85 | 91% |
| Dignity Health | $35 - $85 | 100% |
| Champus | $38 | 108% |
| Kern Family Health Plan | $39 - $85 | 111% |
| Medicare (plans) | $39 | 111% |
| Southland San Gabriel Valley Medical Group | $40 - $238 | 114% |
| Karing Physicians Medical Group | $40 - $178 | 114% |
| Accountable Health | $40 - $142 | 114% |
| Watts Healthcare Mmc | $40 - $108 | 114% |
| Exceptional Care Medical Group | $40 - $536 | 114% |
| Noble Community Medical Associates | $40 - $178 | 114% |
| Family Health Alliance Med Grp | $40 - $174 | 114% |
| Avalon IPA | $40 - $166 | 114% |
| California Pacific Physicians Medical Group | $40 - $208 | 114% |
| Superior Choice Medical Group | $40 - $248 | 114% |
| Serendib Healthways Mmc | $40 - $150 | 114% |
| Healthy New Life Medical Corp | $40 - $208 | 114% |
| El Proyecto Del Barrio | $40 - $108 | 114% |
| Asian Community Medical Group | $40 - $208 | 114% |
| Regent Medical Group | $40 - $178 | 114% |
| Primary Care and Pediatric IPA | $40 - $166 | 114% |
| Mabuhay Medical Group | $40 - $166 | 114% |
| Community Care IPA Mmc | $40 - $167 | 114% |
| Providence Health Network | $337 - $464 | 961% |