CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Adventist Health Tehachapi Valley

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $65
Cash Discount Price: $72
vs. Medicare Baseline: 1.85x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Adventist Health Tehachapi Valley is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $72. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.85x the Medicare baseline. Located in 1100 Magellan, Tehachapi, CA.

Cash / Self-Pay

$72

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $72 (205%)

Insurance Median: $65 (185%)

Cash: $72 (205% of Medicare)

Ins. Median: $65 (185% 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
Bc Mcal	$16	46%
Kaiser Medi-Cal Ip/Op Only	$16	46%
Medi-Cal	$16	46%
Universal Ipa Mcal Op/Profee Only	$16	46%
Healthnet Medi-Cal	$20	57%
Khs-Kern Hlth Systm Mcal	$21	60%
Klhp-Kern Legacy Epo -All Other Plans	$44 - $55	125%
Healthnet Mcare	$51	145%
Medicare (plans)	$51	145%
Tricare	$51	145%
UnitedHealthcare	$51 - $131	145%
Universal Ipa Mcr Adv Op/Profee Only-All Other Pla	$51	145%
Oscar Health Plan- All Plans	$59	168%
Network Providers- All Plans	$65	185%
Kaiser Ip/Op Only- All Other Plans	$88	251%
Blue Shield Epn- All Other Plans	$98	279%
Western Grwrs/Pinnacle - All Plans	$113	322%
Centivo - All Plans	$115	328%
Aetna	$117	334%
Ah Employee Health Plan - All Plans	$142	405%
Blue Cross Blue Shield	$155 - $162	442%
Blue Shield Non-Epn	$171	488%
Healthnet- All Other Plans	$206	587%
Cigna	$209	596%
Coventry- All Plans	$241	687%

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 $72.
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 Tehachapi Valley 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.