CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Adventist Health Reedley

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $60
Cash Discount Price: $43
vs. Medicare Baseline: 1.71x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Adventist Health Reedley is $60. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $43. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.71x the Medicare baseline. Located in 372 W Cypress Ave, Reedley, CA.

Cash / Self-Pay

$43

Average discount available for prompt cash payment at this facility.

Insurance Median

$60

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: $43 (123%)

Insurance Median: $60 (171%)

Cash: $43 (123% of Medicare)

Ins. Median: $60 (171% 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.

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
Cal Viva Hlth Mcal - All Plans	$16	46%
Kern Health Systems Mcal-All Plans	$16	46%
Medi-Cal	$16	46%
Dignity Mcal Op/Profee Only-All Other Plans	$18	51%
Community Care Ipa Mcal-All Plans	$21	60%
Bc Mcal	$22	63%
Healthnet Medi-Cal	$34	97%
Blue Shield Mcare	$37	106%
Dignity Mcr Adv Op/Profee Only	$37	106%
Fhcn Pace Mcr Adv-All Plans	$37	106%
Healthnet- Mcr Adv	$37	106%
Kaiser Mcr Adv	$37	106%
Phs Prime Health Srvcs	$37	106%
Tricare	$37	106%
UnitedHealthcare	$37 - $301	106%
Bright Health Mcr Adv - All Plans	$58	165%
Aetna	$61 - $390	174%
Ah Employee Health Plan - All Plans	$67	191%
Healthnet- All Other Plans	$97	277%
Western Growers/Pinnacle- All Plans	$103	294%
Kaiser - All Other Plans	$112	319%
Blue Shield Epn - All Other Plans	$121	345%
Blue Shield Non Epn	$140	399%
Cigna	$146	416%
Physicians Med Group Op/Profee Only- All Plans	$179	510%
Blue Cross Blue Shield	$393 - $526	1121%

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 $43.
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 Reedley 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.