CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Sharp Chula Vista Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $140
Cash Discount Price: $172
vs. Medicare Baseline: 3.99x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Sharp Chula Vista Medical Center is $140. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $172. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 3.99x the Medicare baseline. Located in 751 Medical Center Court, Chula Vista, CA.

Cash / Self-Pay

$172

Average discount available for prompt cash payment at this facility.

Insurance Median

$140

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: $172 (490%)

Insurance Median: $140 (399%)

Cash: $172 (490% of Medicare)

Ins. Median: $140 (399% 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 399% of the Medicare baseline (a markup of 299%). 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
UnitedHealthcare	$14 - $160	40%
Community Health Group	$64 - $146	182%
Aetna	$68 - $224	194%
Health Net	$68 - $224	194%
Indian Health Council	$68 - $172	194%
Multiplan	$68 - $78	194%
San Diego Pace	$68 - $160	194%
Cigna	$69 - $206	197%
County Medical Services	$69 - $140	197%
Managed Health Network	$89 - $140	254%
California Health And Wellness	$96 - $160	274%
Medicare (plans)	$105 - $183	299%
Molina	$110 - $146	314%
Humana	$114 - $155	325%
Medi-Cal	$126 - $172	359%
Blue Cross Blue Shield	$128 - $183	365%
Allianz Global Assistance	$140	399%
Interplan	$140 - $160	399%
Kaiser	$143 - $146	408%
Epic Americas	$144 - $145	411%
Blue Shield	$160	456%

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 $172.
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 Sharp Chula Vista Medical Center 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.