CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: East Morgan County Hospital

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $77
Cash Discount Price: $65
vs. Medicare Baseline: 2.20x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at East Morgan County Hospital is $77. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $65. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.20x the Medicare baseline. Located in 2400 W Edison St, Brush, CO.

Cash / Self-Pay

$65

Average discount available for prompt cash payment at this facility.

Insurance Median

$77

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: $65 (185%)

Insurance Median: $77 (220%)

Cash: $65 (185% of Medicare)

Ins. Median: $77 (220% 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 220% of the Medicare baseline (a markup of 120%). 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
Pinnacol Assurance Workers Comp	$40	114%
Aetna	$41 - $88	117%
Banner Health	$41	117%
Blue Cross Blue Shield	$41 - $78	117%
Clear Spring Health	$41	117%
Healthspring Life & Health Insurance Company, Inc.	$41	117%
Medica	$41 - $79	117%
Medicare (plans)	$41	117%
Triwest Healthcare Alliance Corp - Va Ccn	$41	117%
UnitedHealthcare	$41 - $88	117%
Longevity	$42	120%
Humana	$43	123%
Devoted Health Services	$45	128%
Assist Health Group	$49	140%
Denver Health Medical Plan	$76	217%
Apostrophe, Inc.	$86	245%
First Choice Health Network	$86	245%
Hue Health, Inc	$90	257%
Rocky Mountain Health Plans	$90	257%
Multiplan	$92	262%

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 $65.
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 East Morgan County 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.