CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Charleston Area Medical Center

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $196
Cash Discount Price: $217
vs. Medicare Baseline: 5.59x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Charleston Area Medical Center is $196. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $217. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 5.59x the Medicare baseline. Located in 501 Morris Street, Charleston, WV.

Cash / Self-Pay

$217

Average discount available for prompt cash payment at this facility.

Insurance Median

$196

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: $217 (619%)

Insurance Median: $196 (559%)

Cash: $217 (619% of Medicare)

Ins. Median: $196 (559% 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 559% of the Medicare baseline (a markup of 459%). 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
Aetna	$29 - $215	83%
The Health Plan Of West Virginia Inc.	$29 - $212	83%
Unicare Health Plan Of West Virginia Inc.	$29	83%
Triwest Va	$32	91%
Blue Cross Blue Shield	$33 - $200	94%
Choicecare Network	$33 - $215	94%
UnitedHealthcare	$34 - $215	97%
West Virginia Senior Advantage Inc.	$34	97%
Optimum Choice Inc.	$39	111%
Integrated Medical Solutions	$64	182%
Naphcare	$65	185%
Caresource	$81	231%
Tricare	$129 - $131	368%
City Of Charleston	$161 - $164	459%
Cigna	$200 - $204	570%
Three Rivers Providers Network	$209 - $212	596%
Healthsmart	$211 - $215	602%
Multiplan	$211 - $215	602%

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 $217.
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 Charleston Area 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.