CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adventist Health Sierra Vista

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $344
Cash Discount Price: $44
vs. Medicare Baseline: 10.62x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health Sierra Vista is $344. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $44. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 10.62x the Medicare baseline. Located in 1010 Murray St, San Luis Obispo, CA.

Cash / Self-Pay

$44

Average discount available for prompt cash payment at this facility.

Insurance Median

$344

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $44 (136%)

Insurance Median: $344 (1062%)

Cash: $44 (136% of Medicare)

Ins. Median: $344 (1062% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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 1062% of the Medicare baseline (a markup of 962%). 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
Aetna	$35 - $468	108%
Cencal Mcr Adv - All Other Plans	$35	108%
Tricare	$35	108%
UnitedHealthcare	$35 - $431	108%
Cfmg-Ca Forensic Med Grp Op/Profee Only-All Plans	$45	139%
Ah Employee Health Plan - All Plans	$63	194%
Hpn-Heritage Prov Ntwrk-All Plans	$152 - $178	469%
Nbd-Ntwrks By Design Exclus-All Other Plans	$259 - $303	799%
Nbd-Ntwrks By Design Non-Exclus	$259 - $303	799%
Blue Shield Epn	$273	843%
Blue Shield Hmo/Pos	$344	1062%
Blue Shield Epo/Ppo-All Other Plans	$373	1151%
Medi-Cal	$448 - $524	1383%
Cencal Mcal	$511 - $597	1577%
Blue Shield Promise Mcal	$538 - $630	1660%
Ccah-Centrl Ca Allince Mcal-All Plans	$582 - $681	1796%
Coalinga-All Plans	$582 - $681	1796%

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 $44.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Adventist Health Sierra Vista is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.