CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: West Valley Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $96
Cash Discount Price: $278
vs. Medicare Baseline: 2.74x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at West Valley Medical Center is $96. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $278. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.74x the Medicare baseline. Located in 1717 Arlington Street, Caldwell, ID.

Cash / Self-Pay

$278

Average discount available for prompt cash payment at this facility.

Insurance Median

$96

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: $278 (793%)

Insurance Median: $96 (274%)

Cash: $278 (793% of Medicare)

Ins. Median: $96 (274% 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 274% of the Medicare baseline (a markup of 174%). 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
Blue Cross Blue Shield	$28 - $3,495	80%
Molina	$28 - $33	80%
Humana	$29 - $233	83%
Regence Blue Shield	$29 - $33	83%
St Luke'S Health Partners	$29 - $181	83%
Veteran'S Administration	$29 - $33	83%
United	$30 - $166	86%
Regence	$84	240%
Select Health Idaho (Eirmc Only)	$89	254%
Corizon Health	$103	294%
True Blue	$110	314%
Cigna	$156	445%
Pacificsource Health	$166	473%
Moda	$173	493%
Aetna	$220	627%
Four Rivers Hospice	$222	633%
Multiplan	$222	633%
Geha Ppo Usa	$236	673%
Coventry First Health	$250	713%
St Alphonsus Health	$250	713%

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 $278.
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 West Valley 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.