CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Vandalia Health Broaddus Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $65
Cash Discount Price: $53
vs. Medicare Baseline: 1.85x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Vandalia Health Broaddus Hospital is $65. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $53. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 1.85x the Medicare baseline. Located in 1 Healthcare Drive Mansfield Hill, Philippi, WV.

Cash / Self-Pay

$53

Average discount available for prompt cash payment at this facility.

Insurance Median

$65

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: $53 (151%)

Insurance Median: $65 (185%)

Cash: $53 (151% of Medicare)

Ins. Median: $65 (185% 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
Peak Health	$13 - $24	37%
Correctional Medical Systems	$25	71%
Aetna	$26 - $68	74%
The Health Plan	$26 - $68	74%
Unicare	$26	74%
Blue Cross Blue Shield	$38 - $54	108%
Highmark	$56	160%
UnitedHealthcare	$56 - $74	160%
Humana	$58	165%
West Virginia Senior Advantage	$59	168%
Cigna	$66	188%
First Health	$68	194%
Geisenger Health Plan	$71	202%
Health Network America	$71 - $72	202%
Multiplan/Phcs	$71	202%
Geha	$72	205%
Selectnet	$74	211%

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 $53.
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 Vandalia Health Broaddus 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.