CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Adventist Health Tulare

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 Tulare 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 869 North Cherry Street, Tulare, 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
Medi-Cal	$16	46%
Dignity Mcal Op Only	$18	51%
Independence Op Only - All Plans	$18	51%
Blue Cross Blue Shield	$19 - $410	54%
Ccipa Medi-Cal - All Plans	$21	60%
Healthnet Medi-Cal	$21	60%
Blue Shield Mcare	$37	106%
Dignity Mcr Op Only - All Other Plans	$37	106%
Fhcn Pace Mcr Adv - All Plans	$37	106%
Medicare (plans)	$37	106%
Prime Health - All Plans	$37	106%
Tricare	$37	106%
UnitedHealthcare	$37 - $602	106%
Prison Hlthcre - All Plans	$47	134%
Cal Forensic Med Grp - All Plans	$48	137%
Lasalle Mg Op Only - All Plans	$50	143%
Bright Health - All Plans	$54	154%
Ah Employee Health Plan - All Plans	$67	191%
Incentive Hlth - All Plans	$67	191%
Healthnet Hmo/Ppo - All Other Plans	$99	282%
Cigna	$104	297%
Western Growers - All Plans	$105	299%
Network By Design-All Plans	$146	416%
Hs Interplan-All Plans	$150	428%
Aetna	$155	442%
Multiplan - All Plans	$190	542%
Blue Shield Epn	$256	730%
Blue Shield-All Other Plans	$356	1015%

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 Tulare 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.