CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Adventist Health Clearlake

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $345
Cash Discount Price: $153
vs. Medicare Baseline: 10.65x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Adventist Health Clearlake is $345. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $153. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 10.65x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$153

Average discount available for prompt cash payment at this facility.

Insurance Median

$345

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: $153 (472%)

Insurance Median: $345 (1065%)

Cash: $153 (472% of Medicare)

Ins. Median: $345 (1065% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 1065% of the Medicare baseline (a markup of 965%). Patients with high-deductible plans or out-of-network benefits may face excessive out-of-pocket costs.

Consult Patient Advocate

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 Managed Mcal	$8	25%
Medi-Cal	$8	25%
Blue Shield Mcr Adv	$89	275%
Kaiser Mcr Adv	$89	275%
Tricare	$89	275%
Blue Cross Blue Shield	$93 - $543	287%
UnitedHealthcare	$98 - $355	302%
Ah Employee Health Plan - All Plans	$179	552%
Aetna	$318	981%
Western Growers- All Plans	$320	988%
Blue Shield Epn - All Other Plans	$326	1006%
Blue Shield Non-Epn	$333	1028%
First Health- All Plans	$341	1052%
Healthnet- All Plans	$349	1077%
Foundation- All Plans	$362	1117%
Health Mgmt Network- All Plans	$362	1117%
Humana	$362	1117%
Phcs- All Plans	$362	1117%
Cigna	$383	1182%
Interplan- All Plans	$383	1182%
Kaiser- All Other Plans	$383	1182%
Three Rivers Provider Network- All Plans	$383	1182%
Partnership Mcal - All Plans	$703	2170%

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 $153.
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 Clearlake 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.