Signature Cross-Insurance Cost Matrix • CPT 975353. Motor, Speech & Daily Living Rehabilitation

Occupational Therapy — Parkinson's ADL, Fine Motor & Home Safety (CPT 97535 / 97165): Cost Across Insurances

Complete cell-by-cell comparison across Self-Pay Cash, Original Medicare, 6 Major California Commercial Payers (Anthem, Blue Shield, UnitedHealthcare, Aetna, Cigna, Kaiser Permanente), and Medi-Cal — with every cell labeled with its official data source and effective date.

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1. Published Prices(Cash & Medicare)2. Plan-Adjusted(Payer MRF Rate)3. Verified Price(Real-Time 270/271 Check)

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Tier 1: General Published Rates Across 9 InsurancesEvery cell labeled with official Source + Date • “Not published” shown honestly where proprietary

Hospital procedure cells are extracted from 14 Bay Area hospital MRFs (45 CFR § 180.50, Oct 2026); medication cells use CMS NADAC (as of 2026-10-28) & CY 2026 Medicare Part D / Medi-Cal Rx rules.

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Parkinson's Service / Medication	Self-Pay / Cash Price Hospital MRF / Retail Cash	Medicare Rate 2026 CMS / NADAC / Part D	Anthem Blue Cross MRF Negotiated / Formulary	Blue Shield of CA MRF Negotiated / Formulary	UnitedHealthcare MRF Negotiated / Formulary	Aetna MRF Negotiated / Formulary	Cigna MRF Negotiated / Formulary	Kaiser Permanente MRF Negotiated / Formulary	Medi-Cal (CA Medicaid) CA DHCS / Medi-Cal Rx
Pathway ServiceCPT 97535 Occupational Therapy — Parkinson's ADL, Fine Motor & Home Safety (CPT 97535 / 97165) 14-Hospital Breakdown →	$70–$240 Self-pay discounted cash / negotiated spread ($16–$905 overall across 14 Bay Area hospitals) Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50) Date: Oct 2026	$36.4 CMS 2026 allowed rate (~$7.28 Part B 20% coinsurance; $0 with Medigap Plan G) Source: CMS CY 2026 Medicare Outpatient Therapy Fee Schedule (CPT 97535 per 15-min unit: $34.13; CPT 97165 OT Evaluation: $105.94) Date: CY 2026 (Jan 2026)	$40–$654 Negotiated across 5 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): ANTHEM BC HMO/IFP ($199); Washington Hospital (Fremont): ANTHEM BC MCR ADV ($40)) Source: Bay Area Hospital MRFs (5/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$41–$706 Negotiated across 3 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Blue Shield (Medicare Managed Care Plan) ($132); Stanford Tri-Valley (Pleasanton): Blue Shield (HMO/POS) ($138)) Source: Bay Area Hospital MRFs (3/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$41–$782 Negotiated across 2 Bay Area hospital MRFs (e.g., UCSF Medical Center (SF): Unitedhealthcare (Medicare Managed Care Plan) ($127); Washington Hospital (Fremont): UHC MCR ADV ($41)) Source: Bay Area Hospital MRFs (2/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$41–$643 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): AETNA MCR ADV ($41); Washington Hospital (Fremont): AETNA-ALL OTHER PLANS ($253)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$218–$724 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): CIGNA NEW BUS OAP ($222)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$16–$489 Negotiated across 1 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): KAISER MCR ADV ($41); Washington Hospital (Fremont): KAISER - ALL OTHER PLANS ($193)) Source: Bay Area Hospital MRFs (1/14 facilities, 45 CFR § 180.50) Date: 2026-10-01	$0 patient copay Medi-Cal Fee-For-Service / Managed Care ($0 beneficiary cost-sharing; provider benchmark ~$29) Source: CA DHCS 2026 Medi-Cal Rates & Cost-Sharing Rules Date: Oct 2026

Audit-Grade Cell Verification (9/9 Insurance Columns Sourced)

Every Insurance Cell for Occupational Therapy — With Source & Date Citations

Tier 1 Cash Baseline Published Rate

Self-Pay / Discounted Cash Price

$70–$240

Self-pay discounted cash / negotiated spread ($16–$905 overall across 14 Bay Area hospitals)

Official Source: 14 Bay Area Hospital MRFs (45 CFR § 180.50)

Effective / Verified Date: Oct 2026

Federal Benchmark Published Rate

Original Medicare (CMS 2026 / NADAC / Part D)

$36.4

CMS 2026 allowed rate (~$7.28 Part B 20% coinsurance; $0 with Medigap Plan G)

Official Source: CMS CY 2026 Medicare Outpatient Therapy Fee Schedule (CPT 97535 per 15-min unit: $34.13; CPT 97165 OT Evaluation: $105.94)

Effective / Verified Date: CY 2026 (Jan 2026)

Commercial & MA MRF Published Rate

Anthem Blue Cross (California)

$40–$654

Negotiated across 5 Bay Area hospital MRFs (e.g., Washington Hospital (Fremont): ANTHEM BC HMO/IFP ($199); Washington Hospital (Fremont): ANTHEM BC MCR ADV ($40))

Official Source: Bay Area Hospital MRFs (5/14 facilities, 45 CFR § 180.50)