CMS Price Transparency Data

Occupational therapy (therapeutic activities)

Facility: HCA Healthone Spalding Rehabilitation

Billing Code: 97530 (CPT)

Factual Cost Summary (Answer Capsule)

CPT Billing Code: 97530
Insurance Median: $97
Cash Discount Price: $337
vs. Medicare Baseline: 2.77x Medicare

The contracted insurance negotiated median rate for a Occupational therapy (therapeutic activities) at HCA Healthone Spalding Rehabilitation is $97. If you are paying out-of-pocket or uninsured, the self-pay cash discount rate is $337. Compared to the federal Medicare reimbursement reference rate of $35.07, this hospital’s rate is 2.77x the Medicare baseline. Located in 900 Potomac St, Aurora, CO.

Cash / Self-Pay

$337

Average discount available for prompt cash payment at this facility.

Insurance Median

$97

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: $337 (961%)

Insurance Median: $97 (277%)

Cash: $337 (961% of Medicare)

Ins. Median: $97 (277% 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 277% of the Medicare baseline (a markup of 177%). 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
Vail Health	$30 - $52	86%
Aetna	$32 - $175	91%
Blue Cross Blue Shield	$32 - $235	91%
Bright Health	$32 - $36	91%
Cigna	$32 - $221	91%
Devoted Health	$32 - $36	91%
Humana	$32 - $36	91%
Mutual Of Omaha	$32 - $36	91%
Rocky Mountain Health	$32 - $36	91%
Total Longterm Care	$32 - $36	91%
Triwest Health Alliance	$32 - $276	91%
United	$32 - $155	91%
Innovage Pace	$33 - $37	94%
Kaiser	$33 - $206	94%
Wellcare	$33 - $38	94%
Delaware Life Insurance	$34 - $38	97%
Western Plains Community Health	$128 - $224	365%
Multiplan	$138 - $310	393%
Pinnacol Workers Comp	$147 - $259	419%
Prime Health	$177 - $310	505%

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 $337.
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 HCA Healthone Spalding Rehabilitation 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.