CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adventist Health Tehachapi Valley

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $41
Cash Discount Price: $39
vs. Medicare Baseline: 1.27x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health Tehachapi Valley is $41. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $39. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 1.27x the Medicare baseline. Located in 1100 Magellan, Tehachapi, CA.

Cash / Self-Pay

$39

Average discount available for prompt cash payment at this facility.

Insurance Median

$41

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: $39 (120%)

Insurance Median: $41 (127%)

Cash: $39 (120% of Medicare)

Ins. Median: $41 (127% 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
Medi-Cal	$5 - $8	15%
Universal Ipa Mcal Op/Profee Only	$5 - $8	15%
Bc Mcal	$8	25%
Kaiser Medi-Cal Ip/Op Only	$8	25%
Healthnet Medi-Cal	$9	28%
Khs-Kern Hlth Systm Mcal	$10	31%
Aetna	$24 - $117	74%
Healthnet Mcare	$34 - $38	105%
Tricare	$34 - $38	105%
UnitedHealthcare	$34 - $99	105%
Universal Ipa Mcr Adv Op/Profee Only-All Other Pla	$34 - $38	105%
Cigna	$37 - $158	114%
Network Providers- All Plans	$37 - $49	114%
Ah Employee Health Plan - All Plans	$38 - $107	117%
Medicare (plans)	$38	117%
Oscar Health Plan- All Plans	$39 - $55	120%
Coventry- All Plans	$41 - $182	127%
Klhp-Kern Legacy Epo -All Other Plans	$44 - $55	136%
Blue Shield Epn- All Other Plans	$45 - $98	139%
Blue Shield Non-Epn	$48 - $171	148%
Western Grwrs/Pinnacle - All Plans	$48 - $85	148%
Blue Cross Blue Shield	$50 - $122	154%
Healthnet- All Other Plans	$50 - $156	154%
Centivo - All Plans	$51 - $86	157%
Kaiser Ip/Op Only- All Other Plans	$66	204%

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 $39.
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 Tehachapi Valley 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.