CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Adventist Health St Helena

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $196
Cash Discount Price: $46
vs. Medicare Baseline: 5.59x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Adventist Health St Helena is $196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $46. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 5.59x the Medicare baseline. Located in 10 Woodland Road, Saint Helena, CA.

Cash / Self-Pay

$46

Average discount available for prompt cash payment at this facility.

Insurance Median

$196

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: $46 (131%)

Insurance Median: $196 (559%)

Cash: $46 (131% of Medicare)

Ins. Median: $196 (559% 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 559% of the Medicare baseline (a markup of 459%). 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
Va Medi-Cal	$16	46%
Blue Shield Bh Mcr Adv	$42	120%
Blue Shield Mcr Adv	$42	120%
Kaiser Mcr Adv	$42	120%
Tricare	$42	120%
UnitedHealthcare	$42 - $196	120%
Va Mcr - All Other Plans	$42	120%
Ah Employee Health Plan - All Plans	$76	217%
Aetna	$128	365%
Blue Shield Behav Hlth	$139	396%
Phcs-All Plans	$169	482%
Healthnet-All Plans	$189	539%
Interplan-All Plans	$200	570%
Choicecare-All Plans	$216	616%
Beech Street-All Plans	$231	659%
Cigna	$246	701%
Kaiser-All Other Plans	$253	721%
Health Management Network-All Plans	$262	747%
Galaxy Network-All Plans	$277	790%
Three Rivers-All Plans	$277	790%
Blue Shield Epn-All Other Plans	$286	816%
Blue Shield Non-Epn	$294	838%
Western Growers-All Plans	$297	847%
Blue Cross Blue Shield	$332 - $447	947%

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 $46.
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 Adventist Health St Helena 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.