CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adventist Health Delano

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $54
Cash Discount Price: $20
vs. Medicare Baseline: 1.67x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health Delano is $54. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $20. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.67x the Medicare baseline. Located in 1401 Garces Highway, Delano, CA.

Cash / Self-Pay

$20

Average discount available for prompt cash payment at this facility.

Insurance Median

$54

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: $20 (62%)

Insurance Median: $54 (167%)

Cash: $20 (62% of Medicare)

Ins. Median: $54 (167% 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.

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
Blue Cross Blue Shield	$6 - $83	19%
Dignty Hlth Mcal Op Only	$8	25%
Kaiser Medi-Cal Ip/Op Only	$8	25%
Medi-Cal	$8	25%
Universal Care Mcal	$8	25%
Healthnet Medi-Cal	$9	28%
Kern Health System Mcal	$10	31%
Blue Shield Epn - All Other Plans	$22	68%
Bakersfield Fam Med Grp-All Plans	$34	105%
Healthnet Mcr Adv	$34	105%
Kern Mcr Adv Dual Dnsp-All Other Plans	$34	105%
Medicare (plans)	$34 - $55	105%
Tricare	$34	105%
UnitedHealthcare	$34 - $72	105%
Universal Care Mcr- All Other Plans	$34	105%
Healthnet- All Other Plans	$53	164%
Kaiser Comm Ip/Op Only- All Other Plans	$59	182%
Coventry- All Plans	$60	185%
Ah Employee Health Plan - All Plans	$62	191%
County Of Kern Network - All Plans	$70	216%
Gem Care- All Plans	$70	216%
Aetna	$74	228%
Foundation For Medical Care Of Kern County - All P	$75	231%
Centivo - All Plans	$77	238%
Cigna	$80	247%
Western Growers - All Plans	$81	250%
Blue Shield Non-Epn	$262	809%

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 $20.
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 Delano 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.