CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Tri-City Medical Center

Billing Code: 97530 (CPT)

The BaseRate · fair price high confidence

A fair price for this

$41

about 1.2× the $35 Medicare rate · typically $28–$63

modeled estimate · not a bill or quote

What this hospital charges insurers

$39

About the fair price

about $2 under the fair price · 1.1× Medicare

Medicare pays $35 Fair price $41 This hospital $39 Cash price $88 Hospital's list price $147

How we calculate the fair BaseRate →

How this hospital compares to other CA hospitals

Highest price of the 9 CA hospitals we have prices for — worth calling around.

Cheapest $13 Priciest $39

Black dot = this hospital, among the 9 CA hospitals with a price for this procedure. Full list below.

A fair price for a Occupational therapy (therapeutic activities) is about $41 (about 1.2× the $35 Medicare rate). Tri-City Medical Center charges insurers about $39, or about $88 in cash — about the fair price. Located in Oceanside, CA.

What each insurance company pays

Which insurers have negotiated a price with this hospital for this procedure — and which haven’t.

5 of 6 major insurers have a published price at this hospital

✓ UnitedHealthcare✓ Blue Cross Blue Shield✓ Aetna✓ Cigna✓ Kaiser Permanente Humana

Crossed out = this hospital hasn’t published a negotiated price for that insurer for this procedure. It doesn’t necessarily mean they aren’t accepted — ask your insurer.

Insurance company	Price range	vs. Medicare
UnitedHealthcaremajor	$247 - $259	704%
Blue Cross Blue Shieldmajor	$68 - $93	194%
Aetnamajor	$28 - $109	80%
Cignamajor	$102 - $123	291%
Kaiser Permanentemajor	$48 - $55	137%
Health Net	$11 - $122	31%
Molina	$41 - $47	117%
Providence Health Plan	$41 - $47	117%
+ 3 smaller / regional plans	$34 - $94

Excludes 1 rental-network / third-party entry (e.g. Multiplan, PHCS) — these are pricing networks, not insurers.

Self-Pay How to get the cash price

Tell the billing desk you want to be billed as self-pay — not through insurance — before your visit.
Ask for the cash / prompt-pay discount in writing, with the exact price (about 88), before you agree to anything.
Get it in writing that they won’t also bill your insurance, so the cash price is what you owe.
Check the CPT code on your bill matches exactly: 97530.

Insurance Before you use insurance

Call your insurance company to confirm Tri-City Medical Center is in-network.
Ask your insurer whether prior approval is required for CPT code 97530.
Confirm the doctor or provider is in-network too — not just the hospital building.
Check your Explanation of Benefits against the hospital’s final itemized bill.

Estimate your out-of-pocket cost

A rough estimate of what you’d pay with insurance (deductible + coinsurance) versus paying the cash price yourself.

How you’d pay

Deductible left to meet ($)

Your coinsurance (%)

Enter your details and press estimate to compare.

Other Procedures at Tri-City Medical Center

Compare: Occupational therapy (therapeutic activities) at other CA hospitals

Insurance negotiated median for the same procedure, sorted lowest first.