CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Multicare Valley Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $62
Cash Discount Price: $78
vs. Medicare Baseline: 1.77x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Multicare Valley Hospital is $62. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $78. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.77x the Medicare baseline. Located in 12606 East Mission Avenue, Spokane Valley, WA.

Cash / Self-Pay

$78

Average discount available for prompt cash payment at this facility.

Insurance Median

$62

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: $78 (222%)

Insurance Median: $62 (177%)

Cash: $78 (222% of Medicare)

Ins. Median: $62 (177% 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
Coordinated Care	$22	63%
Molina	$22	63%
Wellpoint	$22	63%
Community Health Plan Of Washington	$23	66%
UnitedHealthcare	$23 - $42	66%
Premera	$46 - $61	131%
Pacificsource	$53 - $62	151%
Regence/Asuris	$66	188%
First Choice	$75 - $137	214%
Aetna	$91	259%
Cigna	$110	314%
First Health	$141	402%
Multiplan/Phcs	$141	402%
Kaiser	$179	510%

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 $78.
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 Multicare 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.