CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: Saint Joseph Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $160
Cash Discount Price: Unavailable
vs. Medicare Baseline: 4.56x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at Saint Joseph Hospital is $160. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is unavailable. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 4.56x the Medicare baseline. Located in 1375 E 19Th Ave, Denver, CO.

Cash / Self-Pay

Unavailable

Average discount available for prompt cash payment at this facility.

Insurance Median

$160

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%)

Insurance Median: $160 (456%)

Ins. Median: $160 (456% 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 456% of the Medicare baseline (a markup of 356%). 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
UnitedHealthcare	$35 - $195	100%
Select Health	$36	103%
Kaiser Perm Hmo	$52 - $141	148%
Kaiser Self Funded	$64 - $141	182%
Kaiser Perm Ppo/Pos	$65 - $146	185%
Allegiance	$70 - $84	200%
Cigna	$70 - $336	200%
Kaiser Mrp	$70 - $84	200%
Kaiser Snp	$70 - $84	200%
Denv Hlth Med Plan	$93	265%
Aetna	$104 - $301	297%
Blue Cross Blue Shield	$111 - $273	317%
Geha	$112 - $195	319%
Preferred One	$112 - $134	319%
Humana	$118 - $141	336%
Cofinity	$202 - $242	576%
First Health Network	$202 - $242	576%
Private Hlthcare Sys	$210 - $252	599%
Multiplan Inc	$235 - $282	670%
Midlands Choice	$271 - $326	773%

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 $X.
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 Saint Joseph 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.