CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adventist Health Tulare

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $44
Cash Discount Price: $42
vs. Medicare Baseline: 1.36x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health Tulare is $44. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $42. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.36x the Medicare baseline. Located in 869 North Cherry Street, Tulare, CA.

Cash / Self-Pay

$42

Average discount available for prompt cash payment at this facility.

Insurance Median

$44

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: $42 (130%)

Insurance Median: $44 (136%)

Cash: $42 (130% of Medicare)

Ins. Median: $44 (136% 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	$5 - $410	15%
Ccipa Medi-Cal - All Plans	$5 - $10	15%
Healthnet Medi-Cal	$5 - $10	15%
Medi-Cal	$5 - $8	15%
Upn-United Physcn Ntwrk Mcal Profee Only	$5	15%
Dignity Mcal Op Only	$8	25%
Independence Op Only - All Plans	$8	25%
Aetna	$25 - $155	77%
Blue Shield Mcare	$34	105%
Dignity Mcr Op Only - All Other Plans	$34	105%
Fhcn Pace Mcr Adv - All Plans	$34	105%
Medicare (plans)	$34	105%
Prime Health - All Plans	$34	105%
Tricare	$34	105%
UnitedHealthcare	$34 - $602	105%
Upn-United Physcn Ntwrk Mcr Adv Profee Only-All Ot	$34	105%
Ah Employee Health Plan - All Plans	$38 - $61	117%
Incentive Hlth - All Plans	$38 - $61	117%
Cigna	$43 - $138	133%
Hs Interplan-All Plans	$43 - $200	133%
Cal Forensic Med Grp - All Plans	$44	136%
Prison Hlthcre - All Plans	$44	136%
Blue Shield Epn	$45 - $256	139%
Blue Shield-All Other Plans	$48 - $356	148%
Bright Health - All Plans	$49	151%
Healthnet Hmo/Ppo - All Other Plans	$50 - $91	154%
Western Growers - All Plans	$104 - $140	321%
Network By Design-All Plans	$144 - $194	444%
Multiplan - All Plans	$189 - $253	583%

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 $42.
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 Tulare 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.