CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Adventist Health Delano

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $57
Cash Discount Price: $21
vs. Medicare Baseline: 1.63x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Adventist Health Delano is $57. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $21. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.63x the Medicare baseline. Located in 1401 Garces Highway, Delano, CA.

Cash / Self-Pay

$21

Average discount available for prompt cash payment at this facility.

Insurance Median

$57

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: $21 (60%)

Insurance Median: $57 (163%)

Cash: $21 (60% of Medicare)

Ins. Median: $57 (163% 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
Dignty Hlth Mcal Op Only	$16	46%
Kaiser Medi-Cal Ip/Op Only	$16	46%
Medi-Cal	$16	46%
Universal Care Mcal	$16	46%
Blue Cross Blue Shield	$19 - $86	54%
Healthnet Medi-Cal	$19	54%
Kern Health System Mcal	$21	60%
Blue Shield Epn - All Other Plans	$23	66%
Bakersfield Fam Med Grp-All Plans	$37	106%
Healthnet Mcr Adv	$37	106%
Kern Mcr Adv Dual Dnsp-All Other Plans	$37	106%
Medicare (plans)	$37 - $59	106%
Tricare	$37	106%
UnitedHealthcare	$37 - $74	106%
Universal Care Mcr- All Other Plans	$37	106%
Healthnet- All Other Plans	$54	154%
Coventry- All Plans	$62	177%
Kaiser Comm Ip/Op Only- All Other Plans	$64	182%
Ah Employee Health Plan - All Plans	$67	191%
County Of Kern Network - All Plans	$72	205%
Gem Care- All Plans	$72	205%
Aetna	$76	217%
Foundation For Medical Care Of Kern County - All P	$77	220%
Cigna	$82	234%
Western Growers - All Plans	$83	237%
Centivo - All Plans	$84	240%
Blue Shield Non-Epn	$262	747%

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 $21.
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 Delano 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.