CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Paradise Valley Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $39
Cash Discount Price: $39
vs. Medicare Baseline: 1.11x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Paradise Valley Hospital is $39. 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 $35.07, this hospital’s rate is 1.11x the Medicare baseline. Located in 2400 East 4Th St, National City, CA.

Cash / Self-Pay

$39

Average discount available for prompt cash payment at this facility.

Insurance Median

$39

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: $39 (111%)

Insurance Median: $39 (111%)

Cash: $39 (111% of Medicare)

Ins. Median: $39 (111% 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
Aetna	$16 - $50	46%
Blue Sheid Of Promise	$16	46%
County Of San Diego	$16	46%
Golden Physicians Medical Group	$16 - $49	46%
Health Excel Ins	$16 - $39	46%
Heritage Provider Netwrok	$16 - $51	46%
Molina	$16 - $39	46%
Traditional Medi-Cal	$16	46%
UnitedHealthcare	$16 - $39	46%
Health Net Of Ca	$17 - $57	48%
Community Health Group	$19 - $39	54%
Blue Shield Of Ca, Va	$39	111%
Ca Foundation For Medical Care	$39	111%
Central Health	$39	111%
Choice Physicians Network	$39	111%
Clever Care Of Golden State, Inc	$39	111%
Managed Health Network	$39	111%
Medicare (plans)	$39	111%
Renal Payer Solutions	$39	111%
Tricare	$39	111%
Usa Senior Care Network	$39	111%
Verda Health Plan	$39	111%
Brand New Day	$40 - $59	114%
Imperial Health Plan Of Ca	$42	120%
Health Net Federal Service (Cdcr)	$49	140%
Veterans Evaluation Services	$49	140%
Integrated Medical Solutions	$52	148%
Worker Comp	$52	148%
Ca Dept Of Correction & Rehab	$55	157%
Employer Direct Healthcare	$55	157%
Naphcare	$61 - $79	174%
Scripps Health	$67	191%

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: 97530.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Paradise Valley Hospital 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.