CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Sharp Coronado Hospital and Hlthcr Ctr

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $150
Cash Discount Price: $172
vs. Medicare Baseline: 4.28x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Sharp Coronado Hospital and Hlthcr Ctr is $150. 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 4.28x the Medicare baseline. Located in 250 Prospect Place, Coronado, CA.

Cash / Self-Pay

$172

Average discount available for prompt cash payment at this facility.

Insurance Median

$150

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: $150 (428%)

Cash: $172 (490% of Medicare)

Ins. Median: $150 (428% 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 428% of the Medicare baseline (a markup of 328%). 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
Cigna	$34 - $224	97%
Health Net	$68 - $206	194%
Kaiser	$68 - $150	194%
Molina	$68 - $172	194%
San Diego Pace	$68	194%
Aetna	$89 - $172	254%
Interplan	$106 - $183	302%
Community Health Group	$114 - $172	325%
Blue Cross Blue Shield	$128 - $160	365%
California Health And Wellness	$137 - $183	391%
Medicare (plans)	$144	411%
Managed Health Network	$145 - $160	413%
UnitedHealthcare	$146	416%
Blue Shield	$150 - $183	428%
Indian Health Council	$150	428%
Allianz Global Assistance	$153	436%
Humana	$160 - $224	456%
Multiplan	$160	456%
Medi-Cal	$172	490%
County Medical Services	$183	522%

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 Coronado Hospital and Hlthcr Ctr 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.