CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Adventist Health Clearlake

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $182
Cash Discount Price: $78
vs. Medicare Baseline: 5.19x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Adventist Health Clearlake is $182. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 5.19x the Medicare baseline. Located in 15630 18Th Ave - Hwy 53, Clearlake, CA.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$182

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: $78 (222%)

Insurance Median: $182 (519%)

Cash: $78 (222% of Medicare)

Ins. Median: $182 (519% 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.

Elevated Commercial Rate Alert (Value-Gap)

The negotiated rate at this facility is 519% of the Medicare baseline (a markup of 419%). 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	$16	46%
Medi-Cal	$16	46%
Blue Shield Mcr Adv	$45	128%
Kaiser Mcr Adv	$45	128%
Tricare	$45	128%
Blue Cross Blue Shield	$47 - $543	134%
UnitedHealthcare	$50 - $180	143%
Ah Employee Health Plan - All Plans	$91	259%
Aetna	$161	459%
Western Growers- All Plans	$162	462%
First Health- All Plans	$173	493%
Healthnet- All Plans	$177	505%
Foundation- All Plans	$184	525%
Health Mgmt Network- All Plans	$184	525%
Humana	$184	525%
Phcs- All Plans	$184	525%
Cigna	$194	553%
Interplan- All Plans	$194	553%
Kaiser- All Other Plans	$194	553%
Three Rivers Provider Network- All Plans	$194	553%
Blue Shield Epn - All Other Plans	$326	930%
Blue Shield Non-Epn	$333	950%
Partnership Mcal - All 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 $78.
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 Clearlake 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.