CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Adventist Health and Rideout

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $204
Cash Discount Price: $62
vs. Medicare Baseline: 5.82x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Adventist Health and Rideout is $204. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $62. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 5.82x the Medicare baseline. Located in 726 4Th St, Marysville, CA.

Cash / Self-Pay

$62

Average discount available for prompt cash payment at this facility.

Insurance Median

$204

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: $62 (177%)

Insurance Median: $204 (582%)

Cash: $62 (177% of Medicare)

Ins. Median: $204 (582% 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 582% of the Medicare baseline (a markup of 482%). 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
Kaiser Mcal	$16	46%
Medi-Cal	$16	46%
Bc Mcal	$17	48%
Ca Health And Wellness- All Plans	$20	57%
Celtic Mcaid-All Plans	$20	57%
Blue Cross Blue Shield	$37 - $216	106%
Kaiser Mcr Adv	$37	106%
Tricare	$37	106%
UnitedHealthcare	$37 - $243	106%
Healthnet Mcal	$56	160%
Ah Employee Health Plan - All Plans	$67	191%
Aetna	$198	565%
Healthnet Comm-All Other Plans	$204	582%
Kaiser-All Other Plans	$213	607%
Blue Shield Uc Care Members	$224	639%
Cigna	$239	681%
First Health-All Plans	$245	699%
Phcs-All Plans	$246	701%
Interplan-All Plans	$252	719%
Blue Shield-All Other Plans	$266	758%
Multiplan-All Plans	$266	758%
Partnership Hp Mcal -All Plans	$462	1317%

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 $62.
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 and Rideout 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.