CMS Price Transparency Data

Occupational therapy (self-care training)

Facility: Hca-Healthone DBA Swedish Medical Center

Billing Code: 97535 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97535
Insurance Median: $167
Cash Discount Price: $565
vs. Medicare Baseline: 5.15x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (self-care training) at Hca-Healthone DBA Swedish Medical Center is $167. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $565. Compared to the federal Medicare reimbursement reference rate of $32.4, this hospital’s rate is 5.15x the Medicare baseline. Located in 501 E Hampden Ave, Englewood, CO.

Cash / Self-Pay

$565

Average discount available for prompt cash payment at this facility.

Insurance Median

$167

Median negotiated contract rate across all mapped commercial carriers.

Medicare Reference Rate

$32.4

Standard federal government reimbursement rate for this code.

Visual Cost Comparison vs. Medicare

Medicare Reference Baseline: $32.4 (100%)

Cash / Self-Pay: $565 (1744%)

Insurance Median: $167 (515%)

Cash: $565 (1744% of Medicare)

Ins. Median: $167 (515% of Medicare)

Understanding this gauge: We use the federal Medicare rate of $32.4 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 515% of the Medicare baseline (a markup of 415%). 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
Humana	$29 - $33	90%
United	$29 - $276	90%
Aetna	$30 - $324	93%
Blue Cross Blue Shield	$30 - $453	93%
Bright Health	$30 - $184	93%
Cigna	$30 - $392	93%
Devoted Health	$30 - $34	93%
Kaiser	$30 - $198	93%
Mutual Of Omaha	$30 - $34	93%
Rocky Mountain Health	$30 - $34	93%
Total Longterm Care	$30 - $34	93%
Triwest Health Alliance	$30 - $34	93%
Wellcare	$30 - $35	93%
Delaware Life Insurance	$31 - $35	96%
Vail Health	$85 - $93	262%
Colorado Program For Children With Special Needs	$245 - $270	756%
Western Plains Community Health	$362 - $398	1117%
Multiplan	$390 - $551	1204%
Northcare	$390 - $429	1204%
Physician Health Partners	$390 - $429	1204%
Pinnacol Workers Comp	$418 - $460	1290%
Medical Development International	$446 - $490	1377%
Prime Health	$501 - $551	1546%

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 $565.
Request and sign a "Waiver of Insurance Submission" to prevent automatic billing.
Verify CPT Code matches exactly: 97535.

Insurance In-Network Protection Plan

Contact your insurance company to confirm Hca-Healthone DBA Swedish Medical Center is fully in-network.
Ask your insurer if "Prior Authorization" is required for CPT code 97535.
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.